secure2.convio.net
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Submitted URL: https://click.email.geisinger.org/?qs=1e2c19112c2edd8c7a3186668fba54843b4ea64190341cf0996b616d5b0df181f1fa4082998c42de63dbe4b8b655...
Effective URL: https://secure2.convio.net/gss/site/Donation2?df_id=1740&mfc_pref=T&1740.donation=form1&campaign=2021_EOY_Email&appeal=AG21...
Submission: On January 13 via manual from US — Scanned from DE
Effective URL: https://secure2.convio.net/gss/site/Donation2?df_id=1740&mfc_pref=T&1740.donation=form1&campaign=2021_EOY_Email&appeal=AG21...
Submission: On January 13 via manual from US — Scanned from DE
Form analysis 1 forms found in the DOM
Name: process — POST https://secure2.convio.net/gss/site/Donation2
<form name="process" id="ProcessForm" action="https://secure2.convio.net/gss/site/Donation2" method="post" onsubmit="return checkDoubleClick();">
<div class="donation-form-container responsive">
<script type="text/javascript">
<!--
function reloadPage() {
window.location.reload(true);
}
function testAjax() {
var xmlHttp = null;
// Opera 8.0+, Firefox, Chrome, Safari
try {
xmlHttp = new XMLHttpRequest();
} catch (e) {
// Internet Explorer Browsers
try {
xmlHttp = new ActiveXObject("Msxml2.XMLHTTP");
} catch (e) {
try {
xmlHttp = new ActiveXObject("Microsoft.XMLHTTP");
} catch (e) {
return false;
}
}
}
xmlHttp.open('POST', 'AjaxHelper;jsessionid=00000000.app20102b?NONCE_TOKEN=C4B0BC485C7947020915D82939B86326', true);
xmlHttp.send();
}
addOnLoadHandler(testAjax);
//
-->
</script>
<div class="donation-form-content">
<input type="hidden" name="user_donation_amt" id="user_donation_amt" value="">
<input type="hidden" name="company_min_matching_amt" id="company_min_matching_amt" value="">
<input type="hidden" name="currency_locale" id="currency_locale" value="en_US">
<div class="form-row">
<div class="html-caption-container">
<p id="FormTitle" style="text-align: left; font-size: 36px; font-weight: bold;">Make better health easy for all<br>by giving to Geisinger</p>
<p>
</p>
<div id="takeseat" style="font-weight: bold; margin-top: 20px; display: none;"></div>
<div id="behavioralhealth" style="font-weight: bold; margin-top: 20px; display: none;"></div>
<style type="text/css">
<!--
label+div.donation-level-user-entered {
margin-left: 4px;
display: inline-block;
margin-top: 0px;
line-height: 38px;
}
/*Font size for Gift Info, Your Info, Payment Info*/
h2,
span.FormLabelText:nth-child(3) {
display: none;
}
/*Bold font weight for all checkbox labels*/
.generic-repeat-label-checkbox-container>label:nth-child(2),
#tribute_show_honor_fields_row>div:nth-child(1)>label:nth-child(2),
#organization-name-visible_row>div:nth-child(1)>label:nth-child(2),
#anonymous_donation_row>div:nth-child(1)>label:nth-child(2),
#donor_email_opt_in_Row>div:nth-child(1)>label:nth-child(3) {
font-weight: bold !important;
}
.donation-levels {
display: -webkit-flex;
/*display: flex;*/
flex-direction: row;
flex-wrap: wrap;
justify-content: space-between;
}
.don-standard-levels {
width: 55%;
}
div.donation-level-container {
float: left;
margin-right: 20px;
margin-left: 20px;
}
/*div.donation-level-container:nth-child(1), div.donation-level-container:nth-child(4), div.donation-level-container:nth-child(7) {
margin-left: 0px !important;
}*/
.donation-levels {
margin-top: 0px;
}
/*Normal font weight for all form labels*/
form label {
font-weight: normal !important;
}
/*Hides the 'Gift Designation' title above fund selection*/
#single_designee_row>div:nth-child(1)>fieldset:nth-child(1)>legend:nth-child(1) {
display: none;
}
/*Removes required asterisk field*/
div.responsive span.field-required {
display: none;
}
/*'Other Fund' designation container --- Next six CSS codes*/
.custom-field-container {
display: none;
}
#other_fund_input {
float: left;
display: inline;
margin-left: 135px;
margin-top: 15px;
}
h2.section-header-container:nth-child(19) {
float: left;
margin-bottom: 20px;
}
/*Hide the 'Use my gift where it is needed most' container*/
/*.unrestricted-option {
display: none;
}*/
/*Hide the 'Direct my gift to:' radio button only*/
#single_designee_designated {
display: none;
}
/*Begin blue button amount css*/
div.donation-level-container {
float: left;
margin-right: 20px;
display: inline-block;
}
div.responsive input {
vertical-align: initial;
}
div.responsive input[type="text"] {
height: 38px;
}
.designated-option>label:nth-child(2) {
vertical-align: bottom;
}
div.donation-form-container.responsive div#level_standard_row.form-row.form-donation-level .donation-levels .form-content {
-webkit-box-shadow: none;
-moz-box-shadow: none;
box-shadow: none;
min-width: 85px;
text-align: center;
background: #fff;
color: #0093d4;
width: 100%;
padding: 0;
border-radius: 5px;
-moz-border-radius: 5px;
-webkit-border-radius: 5px;
border: 1px solid #0093d4;
font-size: 20px;
height: 48px;
line-height: 48px;
}
/*#level_standardexpanded2923amount is for $250 minimum 'Other' amount*/
#level_standardexpanded2263amount,
#level_standardexpanded2923amount {
border: 1px solid #d9d6cf;
padding: 5px 7px;
border-radius: 5px;
-moz-border-radius: 5px;
-webkit-border-radius: 5px;
width: 80px !important;
height: 48px;
font-size: 20px;
font-weight: bold;
}
/*Hide 'Enter Amount' text in the text field*/
div.donation-level-container:nth-child(10)>div:nth-child(1)>div:nth-child(1)>label:nth-child(2)>div:nth-child(1),
div.donation-level-container:nth-child(11)>div:nth-child(1)>div:nth-child(1)>label:nth-child(2)>div:nth-child(1) {
display: none;
}
div.donation-form-container.responsive .donation-level-input-container.form-input input[type="radio"] {
visibility: hidden;
height: 0px;
width: 0px;
margin: 0;
}
div.donation-level-amount-container,
div.donation-level-label-container {
cursor: pointer;
}
div.donation-form-container div.donation-level-user-entered input[type="text"],
div.donation-form-container div.donation-level-user-entered input,
div.donation-form-container .active div.donation-level-user-entered input {
background: transparent;
border: none !important;
outline: none;
box-shadow: none;
}
/*User Entered Amount*/
div.donation-form-container .donation-level-user-entered label::after {
content: "$";
position: relative;
/* display: inline-block; */
padding: 8px 0;
left: 8px;
top: 0;
font-size: 20px;
font-weight: bold;
line-height: 48px;
}
/*'Other' placeholder text*/
::placeholder {
color: #0093d4;
opacity: 1;
/* Firefox */
}
:hover::placeholder {
color: #ffffff;
opacity: 1;
/* Hover Firefox */
}
:-ms-input-placeholder {
/* Internet Explorer 10-11 */
color: #0093d4;
}
:hover:-ms-input-placeholder {
/* Hover Internet Explorer 10-11 */
color: #ffffff;
}
::-ms-input-placeholder {
/* Microsoft Edge */
color: #0093d4;
}
:hover::-ms-input-placeholder {
/* Hover Microsoft Edge */
color: #ffffff;
}
input#other_fund_input::placeholder {
color: inherit;
opacity: 1;
/* Firefox */
}
input#other_fund_input:-ms-input-placeholder {
/* Internet Explorer 10-11 */
color: inherit;
}
input#other_fund_input::-ms-input-placeholder {
/* Microsoft Edge */
color: inherit;
}
div.donation-form-container.responsive .donation-level-input-container.form-input {
min-width: 104px;
height: inherit;
}
div.donation-form-container.responsive div#level_standard_row.form-row.form-donation-level .donation-levels .form-content:hover,
div.donation-form-container.responsive div#level_standard_row.form-row.form-donation-level .form-content.active,
div.donation-form-container.responsive div#level_standard_row.form-row.form-donation-level .form-content.active {
background: #0093d4;
color: #ffffff;
}
div.donation-level-label-input-container {
position: absolute;
}
div.donation-level-input-container,
div.generic-repeat-label-checkbox-container {
vertical-align: top;
}
div.donation-level-label-container {
display: block;
margin-top: 0px !important;
width: 104px;
font-weight: bold;
}
/*Honoree Information Fields*/
#tribute_type {
width: 8rem;
}
#tribute_notify_recip_street1_row input,
#tribute_notify_recip_street2_row input {
width: 20rem;
}
#tribute_notify_recip_street1_row {
float: left;
}
#tribute_notify_recip_street2_row,
#tribute_notify_recip_state_row,
#tribute_notify_recip_zip_row {
float: left;
margin-left: 10px;
}
#tribute_notify_recip_city_row {
float: left;
}
#tribute_notify_recip_state_row {
width: 13rem;
}
#tribute_notify_recip_zipname {
width: 116px;
}
#tribute_notify_recip_state {
width: 13rem;
}
/*Your Information Fields*/
#billing_title {
width: 8rem;
}
#billing_addr_street1_row input,
#billing_addr_street2_row input {
width: 20rem;
}
#billing_addr_street1_row {
float: left;
}
#billing_addr_street2_row,
#billing_addr_state_row,
#billing_addr_zip_row {
float: left;
margin-left: 10px;
}
#billing_addr_city_row {
float: left;
}
#billing_addr_state_row {
width: 13rem;
}
#billing_addr_zipname {
width: 116px;
}
#billing_addr_state {
width: 13rem;
}
#donor_phone_row {
float: left;
}
#donor_email_address_row {
float: left;
margin-left: 10px;
margin-bottom: 15px;
}
/*Blue drop down arrow for all drop down boxes*/
.donation-form-container.responsive select {
background: #fff url(../icons/dropdown-arrow.png) no-repeat 96% 50% !important;
background-size: auto auto;
background-size: auto auto;
background-size: 16px 11px !important;
-webkit-appearance: none;
-moz-appearance: none;
text-align: inherit;
font-size: inherit;
padding-right: 24px !important;
border: 1px solid #d9d6cf;
padding: 5px 7px;
border-radius: 5px;
-moz-border-radius: 5px;
-webkit-border-radius: 5px;
-webkit-box-shadow: inset 3px 3px 3px #f0f0f0;
-moz-box-shadow: inset 3px 3px 3px #f0f0f0;
box-shadow: inset 3px 3px 3px #f0f0f0;
height: 38px;
}
/*Hides the dropdown arrow in Internet Explorer*/
.donation-form-container.responsive select::-ms-expand {
display: none;
}
/* Payment Information */
#payment_typecc_numbername {
width: 13rem;
}
#payment_typecc_number_row,
#payment_typecc_exp_date_row,
#payment_typecc_cvv_row {
float: left;
}
#payment_typecc_exp_date_row,
#payment_typecc_cvv_row {
margin-left: 10px;
}
#payment_typecc_exp_date_MONTH {
width: 3.5rem;
}
#payment_typecc_exp_date_YEAR {
width: 4.5rem;
}
#payment_typecc_cvvname {
width: 5rem;
}
.cardExpGroup {
margin-top: 3px;
padding: 0px;
}
/* Donate Button Container */
.button-container {
float: left;
}
#payment_cc_container>h3:nth-child(1),
#payment_typecc_type_row>div:nth-child(1)>fieldset:nth-child(1)>legend:nth-child(1) {
display: none;
}
.donation-form-content>div:nth-child(4)>div:nth-child(1)>p:nth-child(2) {
font-size: 24px;
}
/*.amtmonies::before{
content: " $";
}*/
div.responsive button.step-button {
max-width: 225px !important;
}
/*Hide Henry Cancer Center at GWV Fund, JWCH Campaign Fund and Take a Seat, Behavioral Health Fund, GLH SON Scholarship, Nursing Education Fund Options from drop down*/
#single_designee option[value="1061"],
#single_designee option[value="1682"],
#single_designee option[value="1683"],
#single_designee option[value="1701"],
#single_designee option[value="1721"],
#single_designee option[value="1722"] {
display: none;
}
-->
</style>
<script src="https://ajax.googleapis.com/ajax/libs/jquery/3.3.1/jquery.min.js"></script>
<script>
$(document).ready(function() {
$(".donation-level-container-generic-repeat").insertAfter(".custom-field-container");
$(".amtmonies").appendTo("#pstep_finish");
$(".amttimes").insertAfter(".amtmonies");
$(".error").insertAfter("#pstep_finish");
$(".unrestricted-option").remove();
$(".amttimes").hide();
$("#takeseat").hide();
$("#behavioralhealth").hide();
$(".amtmonies").text("250");
$(".amttimes").text(" per month");
$('input[type="radio"]').change(function() {
if ($(this).attr('id') == 'level_standardexpanded2266') {
$(".amtmonies").text("25");
$("#level_standardexpanded2263amount").val('');
$("#level_standardexpanded2923amount").val('');
$('#pstep_finish').prop("disabled", false);
$('.error').hide();
$('.error').text("")
} else if ($(this).attr('id') == 'level_standardexpanded2267') {
$(".amtmonies").text("50");
$("#level_standardexpanded2263amount").val('');
$("#level_standardexpanded2923amount").val('');
$('#pstep_finish').prop("disabled", false);
$('.error').hide();
$('.error').text("")
} else if ($(this).attr('id') == 'level_standardexpanded2268') {
$(".amtmonies").text("75");
$("#level_standardexpanded2263amount").val('');
$("#level_standardexpanded2923amount").val('');
$('#pstep_finish').prop("disabled", false);
$('.error').hide();
$('.error').text("")
} else if ($(this).attr('id') == 'level_standardexpanded2261') {
$(".amtmonies").text("100");
$("#level_standardexpanded2263amount").val('');
$("#level_standardexpanded2923amount").val('');
$('#pstep_finish').prop("disabled", false);
$('.error').hide();
$('.error').text("")
} else if ($(this).attr('id') == 'level_standardexpanded2262') {
$(".amtmonies").text("250");
$("#level_standardexpanded2263amount").val('');
$("#level_standardexpanded2923amount").val('');
$('#pstep_finish').prop("disabled", false);
$('.error').hide();
$('.error').text("")
} else if ($(this).attr('id') == 'level_standardexpanded2565') {
$(".amtmonies").text("500");
$("#level_standardexpanded2263amount").val('');
$("#level_standardexpanded2923amount").val('');
$('#pstep_finish').prop("disabled", false);
$('.error').hide();
$('.error').text("")
} else if ($(this).attr('id') == 'level_standardexpanded2941') {
$(".amtmonies").text("750");
$("#level_standardexpanded2263amount").val('');
$("#level_standardexpanded2923amount").val('');
$('#pstep_finish').prop("disabled", false);
$('.error').hide();
$('.error').text("")
} else if ($(this).attr('id') == 'level_standardexpanded2566') {
$(".amtmonies").text("1,000");
$("#level_standardexpanded2263amount").val('');
$("#level_standardexpanded2923amount").val('');
$('#pstep_finish').prop("disabled", false);
$('.error').hide();
$('.error').text("")
} else if ($(this).attr('id') == 'level_standardexpanded2567') {
$(".amtmonies").text("5,000");
$("#level_standardexpanded2263amount").val('');
$("#level_standardexpanded2923amount").val('');
$('#pstep_finish').prop("disabled", false);
$('.error').hide();
$('.error').text("")
}
});
$("input#level_standardexpanded2263amount").on("change keypress input", function() {
$(".amtmonies").text($(this).val());
});
$('input[name="level_standardexpanded2263amount"]').click(function() {
$(".amtmonies").text("0");
});
$("input#level_standardexpanded2923amount").on("change keypress input", function() {
$(".amtmonies").text($(this).val());
});
$('input[name="level_standardexpanded2923amount"]').click(function() {
$(".amtmonies").text("0");
});
$(function() {
$("#level_standardauto_repeatname").click(function() {
if ($(this).is(":checked")) {
$(".amttimes").show();
} else {
$(".amttimes").hide();
}
});
});
$('#level_standardexpanded2263amount').keyup(function() {
if ($(this).val() < 5) {
$('.error').show();
$('.error').text("Minimum gift amount is $5")
$('#pstep_finish').prop("disabled", true);
//$("#pstep_finish").attr("disabled", "");
} else {
$('.error').hide();
$('.error').text("")
$('#pstep_finish').prop("disabled", false);
//$("#pstep_finish").removeAttr("disabled", "");
}
});
$('#level_standardexpanded2923amount').keyup(function() {
if ($(this).val() < 250) {
$('.error').show();
$('.error').text("Minimum gift amount is $250")
$('#pstep_finish').prop("disabled", true);
//$("#pstep_finish").attr("disabled", "");
} else {
$('.error').hide();
$('.error').text("")
$('#pstep_finish').prop("disabled", false);
//$("#pstep_finish").removeAttr("disabled", "");
}
});
// New Designee picker manipulation without setting "selected"
$('#single_designee option[value="1001"]').insertBefore('#single_designee option[value="1683"]');
//$('#single_designee option[value="1541"]').insertBefore('#single_designee option[value="1683"]');
//$('#single_designee option[value="1001"]').insertBefore('#single_designee option[value="1161"]');
$('#single_designee option[value="1082"]').insertBefore('#single_designee option[value="1161"]');
$('#single_designee option[value="1401"]').insertBefore('#single_designee option[value="1051"]');
$('#single_designee option[value="0"]').remove();
$(function() {
$("#tribute_show_honor_fieldsname").click(function() {
if ($(this).is(":checked")) {
$("#honor-name").show();
} else {
$("#honor-name").hide();
}
});
});
// New named Function for Designee picker
function designeePick() {
if ($('#single_designee').val() == '1099') {
$('#other_fund_input').show();
$('#other_fund_input').prop('required', 'true');
} else {
$('#other_fund_input').hide();
$("#other_fund_input").val('');
$("#other_fund_input").removeAttr('required');
}
}
// New named Function for Take a Seat picker
function takeSeat() {
if ($('#single_designee').val() == '1682') {
$("#level_standardexpanded2262").prop("checked", true).trigger("click");
$('.error').hide();
$('.error').text("")
$('#level_standardexpanded2263amount').val("")
$('#pstep_finish').prop("disabled", false);
$('div.donation-level-container:nth-child(11)').show();
$('div.donation-level-container:nth-child(7)').show();
$('div.donation-level-container:nth-child(1)').hide();
$('div.donation-level-container:nth-child(2)').hide();
$('div.donation-level-container:nth-child(3)').hide();
$('div.donation-level-container:nth-child(4)').hide();
$('div.donation-level-container:nth-child(10)').hide();
$("#takeseat").insertBefore("#single_designee_row");
$('#package_descriptionhidden').val($('#package_descriptionhidden').val() + ' - Take a Seat');
$("#takeseat").show();
$("#takeseat").text(
"With a gift of $250 or more to our general scholarship fund, you can sponsor a seat with a customized nameplate in one of our lecture halls. A Foundation team member will contact you shortly to confirm the details for your nameplate."
);
} else {
$('div.donation-level-container:nth-child(11)').hide();
$('div.donation-level-container:nth-child(1)').show();
$('div.donation-level-container:nth-child(2)').show();
$('div.donation-level-container:nth-child(3)').show();
$('div.donation-level-container:nth-child(4)').show();
$('div.donation-level-container:nth-child(10)').show();
$('div.donation-level-container:nth-child(7)').hide();
$('div.donation-level-container:nth-child(9)').show();
$('#package_descriptionhidden').val($('#package_descriptionhidden').val().split(" - Take a Seat").join(""));
$("#takeseat").hide();
//$("#level_standardexpanded2262").prop("checked", true).trigger("click");
}
}
// New named Function for Behavioral Health Scholarship picker
function behavioralHealth() {
if ($('#single_designee').val() == '1683') {
$("#behavioralhealth").insertBefore("#single_designee_row");
$("#behavioralhealth").show();
$('.error').hide();
$('.error').text("")
$('#level_standardexpanded2923amount').val("")
$("#behavioralhealth").text("An anonymous local donor will automatically double your contribution to this behavioral health scholarship, which will be awarded to a student who is a resident of Luzerne County.");
} else {
$("#behavioralhealth").hide();
}
}
// New named Function for Campaign picker
function CampaignPick() {
if ($('#single_designee').val() == '1701') {
$('#campaign_descriptionhidden').val('JWCH Campaign');
} else if ($('#single_designee').val() == '1061') {
$("#campaign_descriptionhidden").val('Henry Cancer Center Campaign 2020');
} else {
$("#campaign_descriptionhidden").val('');
}
}
// calls named Function for Designee picker on dropdown change
$('#single_designee').change(function() {
designeePick();
});
// calls named Function for Designee picker on page load
designeePick();
// calls named Function for takeSeat picker on dropdown change
$('#single_designee').change(function() {
takeSeat();
});
// calls named Function for takeSeat picker on page load
takeSeat();
// calls named Function for behavioralHealth picker on dropdown change
$('#single_designee').change(function() {
behavioralHealth();
});
// calls named Function for behavioralHealth picker on page load
behavioralHealth();
// calls named Function for CampaignPick picker on dropdown change
$('#single_designee').change(function() {
CampaignPick();
});
// calls named Function for CampaignPick picker on page load
CampaignPick();
$("#honor-name").insertBefore("#tribute_notify_recip_name_row");
$("#other_fund_input").insertAfter("#single_designee");
$(".form-input-label-block > label:nth-child(1)").hide();
$("#single_designee_designated").prop("checked", true).trigger("click");
$("#level_standardexpanded2263amount").attr("placeholder", "Other");
$("#level_standardexpanded2923amount").attr("placeholder", "Other");
//$('#single_designee option[value="1682"]').remove();
//$("#level_standardexpanded2923amount").attr("oninput", "this.value = this.value.replace(/[^0-9.]/g, '').replace(/(\..*)\./g, '$111111')");
$("div.donation-level-container:nth-child(7)").hide();
$("div.donation-level-container:nth-child(11)").hide();
$("#other_fund_input").attr("placeholder", "Please Input Fund Designation");
}); //Now closes "(document).ready(function()"
jQuery(function() {
jQuery('div.donation-form-container.responsive div#level_standard_row.form-row.form-donation-level .donation-levels .form-content').find('input[type="radio"]').each(function() {
var syncAction = function(obj) {
if (obj.is(':checked')) {
obj.closest('div.form-content').addClass('active');
} else {
obj.closest('div.form-content').removeClass('active');
};
return arguments.callee;
}(jQuery(this));
jQuery(this).click(function() {
jQuery('div.form-content').removeClass('active');
syncAction(jQuery(this));
});
});
});
$(document).ready(function() {
// Parameters for web pages: &direct=other&fund=PrayerNet
// Read a page's GET URL variables and return them as an associative array.
function getUrlVars() {
var vars = [],
hash;
var hashes = window.location.href.slice(window.location.href.indexOf('?') + 1).split('&');
for (var i = 0; i < hashes.length; i++) {
hash = hashes[i].split('=');
vars.push(hash[0]);
vars[hash[0]] = hash[1];
}
return vars;
}
var direct = getUrlVars()["direct"];
var fund = getUrlVars()["fund"];
var mailing = getUrlVars()["mailing"];
var amount = getUrlVars()["amount"];
var segment = getUrlVars()["segment"];
var topic = getUrlVars()["topic"];
var month = getUrlVars()["month"];
var channel = getUrlVars()["channel"];
var fund_option = getUrlVariable()["fund_option"];
var donation_form = getUrlVariable()["donation_form"];
var event = getUrlVariable()["event"];
var campaign = getUrlVariable()["campaign"];
if (direct == "other") {
$('#other_fund_input').val(decodeURI(fund));
$('#single_designee').val('1099');
$('#other_fund_input').show();
$('#single_designee option[value="1061"]').remove();
$('#single_designee option[value="1682"]').remove();
$('#single_designee option[value="1683"]').remove();
$('#single_designee option[value="1701"]').remove();
$('#single_designee option[value="1721"]').remove();
$('#single_designee option[value="1722"]').remove();
} else if (event == "Marworth_Clean_Sober_Fun_Run") {
$('#other_fund_input').val("Marworth Therapeutic Activities Fund");
$('#single_designee').val('1099');
$('#other_fund_input').show();
$('#single_designee option[value="1061"]').remove();
$('#single_designee option[value="1682"]').remove();
$('#single_designee option[value="1683"]').remove();
$('#single_designee option[value="1701"]').remove();
$('#single_designee option[value="1721"]').remove();
$('#single_designee option[value="1722"]').remove();
$('#single_designee option[value="1001"]').remove();
$('#single_designee option[value="1541"]').remove();
$('#single_designee option[value="1082"]').remove();
$('#single_designee option[value="1161"]').remove();
$('#single_designee option[value="1401"]').remove();
$('#single_designee option[value="1051"]').remove();
$('#single_designee option[value="1055"]').remove();
$('#single_designee option[value="1561"]').remove();
$('#single_designee option[value="1461"]').remove();
$('#single_designee option[value="1321"]').remove();
$('#single_designee option[value="1052"]').remove();
$('#single_designee option[value="1056"]').remove();
$('#single_designee option[value="1054"]').remove();
$("#FormTitle").text("2021 Marworth Clean and Sober Fun Run");
$('#appeal_descriptionhidden').val("2021 Marworth Clean and Sober Fun Run");
$('#package_descriptionhidden').val('Donation');
} else if (donation_form == "main") {
$('#single_designee option[value="1061"]').remove();
$('#single_designee option[value="1682"]').remove();
$('#single_designee option[value="1683"]').remove();
$('#single_designee option[value="1701"]').remove();
$('#single_designee option[value="1721"]').remove();
$('#single_designee option[value="1722"]').remove();
} else if (direct == "Janet%20Weis%20Children%27s%20Hospital") {
$('#single_designee').val('1082');
$('#single_designee option[value="1061"]').remove();
$('#single_designee option[value="1682"]').remove();
$('#single_designee option[value="1683"]').remove();
$('#single_designee option[value="1701"]').remove();
$('#single_designee option[value="1721"]').remove();
$('#single_designee option[value="1722"]').remove();
} else if (direct == "Fresh%20Food%20Farmacy") {
$('#single_designee').val('1161');
$('#single_designee option[value="1061"]').remove();
$('#single_designee option[value="1682"]').remove();
$('#single_designee option[value="1683"]').remove();
$('#single_designee option[value="1701"]').remove();
$('#single_designee option[value="1721"]').remove();
$('#single_designee option[value="1722"]').remove();
} else if (direct == "Geisinger%20Commonwealth%20School%20of%20Medicine") {
$('#single_designee').val('1401');
$('#single_designee option[value="1061"]').remove();
$('#single_designee option[value="1682"]').remove();
$('#single_designee option[value="1683"]').remove();
$('#single_designee option[value="1701"]').remove();
$('#single_designee option[value="1721"]').remove();
$('#single_designee option[value="1722"]').remove();
} else if (segment == "gp_email_journey") {
$('#appeal_descriptionhidden').val("AG - CY 2021 Grateful Patient Email Journey");
$('#package_descriptionhidden').val(decodeURI(month) + ' Patient');
$('#single_designee').val('1001');
$('#single_designee option[value="1061"]').remove();
$('#single_designee option[value="1682"]').remove();
$('#single_designee option[value="1683"]').remove();
$('#single_designee option[value="1701"]').remove();
$('#single_designee option[value="1721"]').remove();
$('#single_designee option[value="1722"]').remove();
} else if (segment == "quarterly_impact_report") {
$('#appeal_descriptionhidden').val("AG - FY 2021 Quarterly Impact Report Email");
$('#single_designee').val('1001');
$('#single_designee option[value="1061"]').remove();
$('#single_designee option[value="1682"]').remove();
$('#single_designee option[value="1683"]').remove();
$('#single_designee option[value="1701"]').remove();
$('#single_designee option[value="1721"]').remove();
$('#single_designee option[value="1722"]').remove();
} else if (channel == "gcsom_website" && segment == "take_a_seat") {
$("#FormTitle").text("Support the future of health with a gift to Geisinger Commonwealth School of Medicine");
$("#FormTitle").css("font-size", "34px");
$("#level_standardexpanded2262").prop("checked", true).trigger("click");
$('#appeal_descriptionhidden').val("GCSOM - Website Giving");
$('#package_descriptionhidden').val('Take a Seat');
$(".amtmonies").text("250");
$('#single_designee option[value="1541"]').remove();
$('#single_designee option[value="1082"]').remove();
$('#single_designee option[value="1161"]').remove();
$('#single_designee option[value="1051"]').remove();
$('#single_designee option[value="1055"]').remove();
$('#single_designee option[value="1561"]').remove();
$('#single_designee option[value="1288"]').remove();
$('#single_designee option[value="1461"]').remove();
$('#single_designee option[value="1321"]').remove();
$('#single_designee option[value="1052"]').remove();
$('#single_designee option[value="1056"]').remove();
$('#single_designee option[value="1054"]').remove();
$('#single_designee option[value="1001"]').remove();
$('#single_designee option[value="1061"]').remove();
$('#single_designee option[value="1061"]').remove();
$('#single_designee option[value="1099"]').remove();
$('#single_designee option[value="1701"]').remove();
$('#single_designee option[value="1721"]').remove();
$('#single_designee option[value="1722"]').remove();
$('#single_designee option[value="1682"]').show();
$('#single_designee option[value="1682"]').trigger("click");
$('#single_designee option[value="1683"]').remove();
$('#single_designee option[value="1401"]').remove();
$('#single_designee option[value="1682"]').insertBefore('#single_designee option[value="1099"]');
$('#single_designee').val('1682');
$('#pstep_finish').prop("disabled", false);
$('div.donation-level-container:nth-child(11)').show();
$('div.donation-level-container:nth-child(7)').show();
$('div.donation-level-container:nth-child(1)').hide();
$('div.donation-level-container:nth-child(2)').hide();
$('div.donation-level-container:nth-child(3)').hide();
$('div.donation-level-container:nth-child(4)').hide();
$('div.donation-level-container:nth-child(10)').hide();
$("#takeseat").insertBefore("#single_designee_row");
$("#takeseat").show();
$("#takeseat").text(
"With a gift of $250 or more to our general scholarship fund, you can sponsor a seat with a customized nameplate in one of our lecture halls. A Foundation team member will contact you shortly to confirm the details for your nameplate."
);
} else if (channel == "gcsom_website" && segment == "behavioral_health") {
$("#FormTitle").text("Support the future of health with a gift to Geisinger Commonwealth School of Medicine");
$("#FormTitle").css("font-size", "34px");
$("#level_standardexpanded2262").prop("checked", true).trigger("click");
$('#appeal_descriptionhidden').val("GCSOM - Website Giving");
$('#package_descriptionhidden').val('Behavioral Health Scholarship');
$(".amtmonies").text("250");
$('#single_designee option[value="1541"]').remove();
$('#single_designee option[value="1082"]').remove();
$('#single_designee option[value="1161"]').remove();
$('#single_designee option[value="1051"]').remove();
$('#single_designee option[value="1055"]').remove();
$('#single_designee option[value="1561"]').remove();
$('#single_designee option[value="1288"]').remove();
$('#single_designee option[value="1461"]').remove();
$('#single_designee option[value="1321"]').remove();
$('#single_designee option[value="1052"]').remove();
$('#single_designee option[value="1056"]').remove();
$('#single_designee option[value="1054"]').remove();
$('#single_designee option[value="1001"]').remove();
$('#single_designee option[value="1061"]').remove();
$('#single_designee option[value="1061"]').remove();
$('#single_designee option[value="1099"]').remove();
$('#single_designee option[value="1721"]').remove();
$('#single_designee option[value="1722"]').remove();
$('#single_designee option[value="1682"]').show();
$('#single_designee option[value="1683"]').show();
$('#single_designee option[value="1401"]').remove();
$('#single_designee option[value="1682"]').remove();
$('#single_designee').val('1683');
$("#behavioralhealth").insertBefore("#single_designee_row");
$("#behavioralhealth").show();
$("#behavioralhealth").text("An anonymous local donor will automatically double your contribution to this behavioral health scholarship, which will be awarded to a student who is a resident of Luzerne County.");
} else if (channel == "gcsom_website" && segment == "student_scholarship") {
$("#FormTitle").text("Support the future of health with a gift to Geisinger Commonwealth School of Medicine");
$("#FormTitle").css("font-size", "34px");
$("#level_standardexpanded2262").prop("checked", true).trigger("click");
$('#appeal_descriptionhidden').val("GCSOM - Website Giving");
$('#package_descriptionhidden').val('Student Scholarship');
$(".amtmonies").text("250");
$('#single_designee option[value="1541"]').remove();
$('#single_designee option[value="1082"]').remove();
$('#single_designee option[value="1161"]').remove();
$('#single_designee option[value="1051"]').remove();
$('#single_designee option[value="1055"]').remove();
$('#single_designee option[value="1561"]').remove();
$('#single_designee option[value="1288"]').remove();
$('#single_designee option[value="1461"]').remove();
$('#single_designee option[value="1321"]').remove();
$('#single_designee option[value="1052"]').remove();
$('#single_designee option[value="1056"]').remove();
$('#single_designee option[value="1054"]').remove();
$('#single_designee option[value="1001"]').remove();
$('#single_designee option[value="1061"]').remove();
$('#single_designee option[value="1061"]').remove();
$('#single_designee option[value="1099"]').remove();
$('#single_designee option[value="1721"]').remove();
$('#single_designee option[value="1722"]').remove();
$('#single_designee option[value="1682"]').show();
$('#single_designee option[value="1683"]').remove();
$('#single_designee option[value="1701"]').remove();
$('#single_designee option[value="1401"]').text("Student Scholarships");
$('#single_designee option[value="1682"]').remove();
$('#single_designee').val('1401');
} else if (mailing == "2021_September_DM" && segment == "GP") {
$("#level_standardexpanded2262").prop("checked", true).trigger("click");
$('#appeal_descriptionhidden').val("AG - CY 2021 September Direct Mail");
$('#package_descriptionhidden').val('August Patient');
$(".amtmonies").text("250");
$('#single_designee option[value="1541"]').remove();
$('#single_designee option[value="1082"]').remove();
$('#single_designee option[value="1161"]').remove();
$('#single_designee option[value="1051"]').remove();
$('#single_designee option[value="1055"]').remove();
$('#single_designee option[value="1288"]').remove();
$('#single_designee option[value="1461"]').remove();
$('#single_designee option[value="1321"]').remove();
$('#single_designee option[value="1052"]').remove();
$('#single_designee option[value="1056"]').remove();
$('#single_designee option[value="1054"]').remove();
$('#single_designee option[value="1682"]').remove();
$('#single_designee option[value="1683"]').remove();
$('#single_designee option[value="1403"]').remove();
$('#single_designee option[value="1721"]').remove();
$('#single_designee option[value="1722"]').remove();
$('#single_designee option[value="1701"]').show();
$('#single_designee option[value="1561"]').remove();
$('#single_designee option[value="1061"]').show();
$('#single_designee').val('1001');
} else if (mailing == "2021_October_DM" && segment == "GP") {
$("#level_standardexpanded2267").prop("checked", true).trigger("click");
$('#appeal_descriptionhidden').val("AG - CY 2021 October Grateful Patient Direct Mail");
$('#package_descriptionhidden').val('September Patient');
$(".amtmonies").text("50");
$('#single_designee option[value="1541"]').remove();
$('#single_designee option[value="1082"]').remove();
$('#single_designee option[value="1161"]').remove();
$('#single_designee option[value="1051"]').remove();
$('#single_designee option[value="1055"]').remove();
$('#single_designee option[value="1288"]').remove();
$('#single_designee option[value="1461"]').remove();
$('#single_designee option[value="1321"]').remove();
$('#single_designee option[value="1052"]').remove();
$('#single_designee option[value="1056"]').remove();
$('#single_designee option[value="1054"]').remove();
$('#single_designee option[value="1682"]').remove();
$('#single_designee option[value="1683"]').remove();
$('#single_designee option[value="1403"]').remove();
$('#single_designee option[value="1721"]').remove();
$('#single_designee option[value="1722"]').remove();
$('#single_designee option[value="1701"]').show();
$('#single_designee option[value="1561"]').remove();
$('#single_designee option[value="1061"]').show();
$('#single_designee').val('1001');
} else if (mailing == "2021_November_DM" && segment == "GP") {
$("#level_standardexpanded2267").prop("checked", true).trigger("click");
$('#appeal_descriptionhidden').val("AG - CY 2021 November Grateful Patient Direct Mail");
$('#package_descriptionhidden').val('October Patient');
$(".amtmonies").text("50");
$('#single_designee option[value="1541"]').remove();
$('#single_designee option[value="1082"]').remove();
$('#single_designee option[value="1161"]').remove();
$('#single_designee option[value="1051"]').remove();
$('#single_designee option[value="1055"]').remove();
$('#single_designee option[value="1288"]').remove();
$('#single_designee option[value="1461"]').remove();
$('#single_designee option[value="1321"]').remove();
$('#single_designee option[value="1052"]').remove();
$('#single_designee option[value="1056"]').remove();
$('#single_designee option[value="1054"]').remove();
$('#single_designee option[value="1682"]').remove();
$('#single_designee option[value="1683"]').remove();
$('#single_designee option[value="1403"]').remove();
$('#single_designee option[value="1721"]').remove();
$('#single_designee option[value="1722"]').remove();
$('#single_designee option[value="1701"]').show();
$('#single_designee option[value="1561"]').remove();
$('#single_designee option[value="1061"]').show();
$('#single_designee').val('1001');
} else if (mailing == "2021_November_GTDM" && segment == "D") {
$("#level_standardexpanded2565").prop("checked", true).trigger("click");
$('#appeal_descriptionhidden').val("AG - CY 2021 November Giving Tuesday Direct Mail");
$('#package_descriptionhidden').val('Donor');
$(".amtmonies").text("500");
$('#single_designee option[value="1541"]').remove();
$('#single_designee option[value="1082"]').remove();
$('#single_designee option[value="1161"]').remove();
$('#single_designee option[value="1051"]').remove();
$('#single_designee option[value="1055"]').remove();
$('#single_designee option[value="1288"]').remove();
$('#single_designee option[value="1461"]').remove();
$('#single_designee option[value="1321"]').remove();
$('#single_designee option[value="1052"]').remove();
$('#single_designee option[value="1056"]').remove();
$('#single_designee option[value="1054"]').remove();
$('#single_designee option[value="1682"]').remove();
$('#single_designee option[value="1683"]').remove();
$('#single_designee option[value="1403"]').remove();
$('#single_designee option[value="1721"]').remove();
$('#single_designee option[value="1722"]').remove();
$('#single_designee option[value="1701"]').show();
$('#single_designee option[value="1561"]').remove();
$('#single_designee option[value="1061"]').show();
$('#single_designee').val('1001');
} else if (mailing == "2021_November_GTDM" && segment == "P") {
$("#level_standardexpanded2262").prop("checked", true).trigger("click");
$('#appeal_descriptionhidden').val("AG - CY 2021 November Giving Tuesday Direct Mail");
$('#package_descriptionhidden').val('Patient');
$(".amtmonies").text("250");
$('#single_designee option[value="1541"]').remove();
$('#single_designee option[value="1082"]').remove();
$('#single_designee option[value="1161"]').remove();
$('#single_designee option[value="1051"]').remove();
$('#single_designee option[value="1055"]').remove();
$('#single_designee option[value="1288"]').remove();
$('#single_designee option[value="1461"]').remove();
$('#single_designee option[value="1321"]').remove();
$('#single_designee option[value="1052"]').remove();
$('#single_designee option[value="1056"]').remove();
$('#single_designee option[value="1054"]').remove();
$('#single_designee option[value="1682"]').remove();
$('#single_designee option[value="1683"]').remove();
$('#single_designee option[value="1403"]').remove();
$('#single_designee option[value="1721"]').remove();
$('#single_designee option[value="1722"]').remove();
$('#single_designee option[value="1701"]').show();
$('#single_designee option[value="1561"]').remove();
$('#single_designee option[value="1061"]').show();
$('#single_designee').val('1001');
} else if (mailing == "2021_September_DM" && segment == "CD") {
$("#level_standardexpanded2262").prop("checked", true).trigger("click");
$('#appeal_descriptionhidden').val("AG - CY 2021 September Direct Mail");
$('#package_descriptionhidden').val('Current Donor');
$(".amtmonies").text("250");
$('#single_designee option[value="1541"]').remove();
$('#single_designee option[value="1082"]').remove();
$('#single_designee option[value="1161"]').remove();
$('#single_designee option[value="1051"]').remove();
$('#single_designee option[value="1055"]').remove();
$('#single_designee option[value="1288"]').remove();
$('#single_designee option[value="1461"]').remove();
$('#single_designee option[value="1321"]').remove();
$('#single_designee option[value="1052"]').remove();
$('#single_designee option[value="1056"]').remove();
$('#single_designee option[value="1054"]').remove();
$('#single_designee option[value="1682"]').remove();
$('#single_designee option[value="1683"]').remove();
$('#single_designee option[value="1403"]').remove();
$('#single_designee option[value="1721"]').remove();
$('#single_designee option[value="1722"]').remove();
$('#single_designee option[value="1701"]').show();
$('#single_designee option[value="1561"]').remove();
$('#single_designee option[value="1061"]').show();
$('#single_designee').val('1001');
} else if (mailing == "2021_September_DM" && segment == "LYBUNT") {
$("#level_standardexpanded2262").prop("checked", true).trigger("click");
$('#appeal_descriptionhidden').val("AG - CY 2021 September Direct Mail");
$('#package_descriptionhidden').val('LYBUNT');
$(".amtmonies").text("250");
$('#single_designee option[value="1541"]').remove();
$('#single_designee option[value="1082"]').remove();
$('#single_designee option[value="1161"]').remove();
$('#single_designee option[value="1051"]').remove();
$('#single_designee option[value="1055"]').remove();
$('#single_designee option[value="1288"]').remove();
$('#single_designee option[value="1461"]').remove();
$('#single_designee option[value="1321"]').remove();
$('#single_designee option[value="1052"]').remove();
$('#single_designee option[value="1056"]').remove();
$('#single_designee option[value="1054"]').remove();
$('#single_designee option[value="1682"]').remove();
$('#single_designee option[value="1683"]').remove();
$('#single_designee option[value="1403"]').remove();
$('#single_designee option[value="1721"]').remove();
$('#single_designee option[value="1722"]').remove();
$('#single_designee option[value="1701"]').show();
$('#single_designee option[value="1561"]').remove();
$('#single_designee option[value="1061"]').show();
$('#single_designee').val('1001');
} else if (mailing == "2021_September_DM" && segment == "SYBUNT") {
$("#level_standardexpanded2262").prop("checked", true).trigger("click");
$('#appeal_descriptionhidden').val("AG - CY 2021 September Direct Mail");
$('#package_descriptionhidden').val('SYBUNT');
$(".amtmonies").text("250");
$('#single_designee option[value="1541"]').remove();
$('#single_designee option[value="1082"]').remove();
$('#single_designee option[value="1161"]').remove();
$('#single_designee option[value="1051"]').remove();
$('#single_designee option[value="1055"]').remove();
$('#single_designee option[value="1288"]').remove();
$('#single_designee option[value="1461"]').remove();
$('#single_designee option[value="1321"]').remove();
$('#single_designee option[value="1052"]').remove();
$('#single_designee option[value="1056"]').remove();
$('#single_designee option[value="1054"]').remove();
$('#single_designee option[value="1682"]').remove();
$('#single_designee option[value="1683"]').remove();
$('#single_designee option[value="1403"]').remove();
$('#single_designee option[value="1721"]').remove();
$('#single_designee option[value="1722"]').remove();
$('#single_designee option[value="1701"]').show();
$('#single_designee option[value="1561"]').remove();
$('#single_designee option[value="1061"]').show();
$('#single_designee').val('1001');
} else if (mailing == "2021_September_GP" && segment == "GP_Email_Journey") {
$('#appeal_descriptionhidden').val("AG - CY 2021 Grateful Patient Email Journey");
$('#package_descriptionhidden').val('August Patient');
$(".amtmonies").text("250");
$('#single_designee option[value="1541"]').remove();
$('#single_designee option[value="1082"]').remove();
$('#single_designee option[value="1161"]').remove();
$('#single_designee option[value="1051"]').remove();
$('#single_designee option[value="1055"]').remove();
$('#single_designee option[value="1288"]').remove();
$('#single_designee option[value="1461"]').remove();
$('#single_designee option[value="1321"]').remove();
$('#single_designee option[value="1052"]').remove();
$('#single_designee option[value="1056"]').remove();
$('#single_designee option[value="1054"]').remove();
$('#single_designee option[value="1682"]').remove();
$('#single_designee option[value="1683"]').remove();
$('#single_designee option[value="1403"]').remove();
$('#single_designee option[value="1721"]').remove();
$('#single_designee option[value="1722"]').remove();
$('#single_designee option[value="1701"]').show();
$('#single_designee option[value="1561"]').remove();
$('#single_designee option[value="1061"]').show();
$('#single_designee').val('1001');
} else if (campaign == "2021_EOY_Email") {
$('#single_designee option[value="1541"]').remove();
$('#single_designee option[value="1082"]').remove();
$('#single_designee option[value="1161"]').remove();
$('#single_designee option[value="1051"]').remove();
$('#single_designee option[value="1055"]').remove();
$('#single_designee option[value="1288"]').remove();
$('#single_designee option[value="1461"]').remove();
$('#single_designee option[value="1321"]').remove();
$('#single_designee option[value="1052"]').remove();
$('#single_designee option[value="1056"]').remove();
$('#single_designee option[value="1054"]').remove();
$('#single_designee option[value="1682"]').remove();
$('#single_designee option[value="1683"]').remove();
$('#single_designee option[value="1403"]').remove();
$('#single_designee option[value="1721"]').remove();
$('#single_designee option[value="1722"]').remove();
$('#single_designee option[value="1701"]').show();
$('#single_designee option[value="1061"]').show();
} else if (mailing == "2021_December_DM" && segment == "CD") {
$("#level_standardexpanded2565").prop("checked", true).trigger("click");
$('#appeal_descriptionhidden').val("AG - CY 2021 December Direct Mail");
$('#package_descriptionhidden').val('Current Donor');
$(".amtmonies").text("500");
$('#single_designee option[value="1541"]').remove();
$('#single_designee option[value="1082"]').remove();
$('#single_designee option[value="1161"]').remove();
$('#single_designee option[value="1051"]').remove();
$('#single_designee option[value="1055"]').remove();
$('#single_designee option[value="1288"]').remove();
$('#single_designee option[value="1461"]').remove();
$('#single_designee option[value="1321"]').remove();
$('#single_designee option[value="1052"]').remove();
$('#single_designee option[value="1056"]').remove();
$('#single_designee option[value="1054"]').remove();
$('#single_designee option[value="1682"]').remove();
$('#single_designee option[value="1683"]').remove();
$('#single_designee option[value="1403"]').remove();
$('#single_designee option[value="1721"]').remove();
$('#single_designee option[value="1722"]').remove();
$('#single_designee option[value="1701"]').show();
$('#single_designee option[value="1561"]').remove();
$('#single_designee option[value="1061"]').show();
$('#single_designee').val('1001');
} else if (mailing == "2021_December_DM" && segment == "LYBUNT") {
$("#level_standardexpanded2565").prop("checked", true).trigger("click");
$('#appeal_descriptionhidden').val("AG - CY 2021 December Direct Mail");
$('#package_descriptionhidden').val('LYBUNT');
$(".amtmonies").text("500");
$('#single_designee option[value="1541"]').remove();
$('#single_designee option[value="1082"]').remove();
$('#single_designee option[value="1161"]').remove();
$('#single_designee option[value="1051"]').remove();
$('#single_designee option[value="1055"]').remove();
$('#single_designee option[value="1288"]').remove();
$('#single_designee option[value="1461"]').remove();
$('#single_designee option[value="1321"]').remove();
$('#single_designee option[value="1052"]').remove();
$('#single_designee option[value="1056"]').remove();
$('#single_designee option[value="1054"]').remove();
$('#single_designee option[value="1682"]').remove();
$('#single_designee option[value="1683"]').remove();
$('#single_designee option[value="1403"]').remove();
$('#single_designee option[value="1721"]').remove();
$('#single_designee option[value="1722"]').remove();
$('#single_designee option[value="1701"]').show();
$('#single_designee option[value="1561"]').remove();
$('#single_designee option[value="1061"]').show();
$('#single_designee').val('1001');
} else if (mailing == "2021_December_DM" && segment == "GP") {
$("#level_standardexpanded2262").prop("checked", true).trigger("click");
$('#appeal_descriptionhidden').val("AG - CY 2021 December Direct Mail");
$('#package_descriptionhidden').val('Patient');
$(".amtmonies").text("250");
$('#single_designee option[value="1541"]').remove();
$('#single_designee option[value="1082"]').remove();
$('#single_designee option[value="1161"]').remove();
$('#single_designee option[value="1051"]').remove();
$('#single_designee option[value="1055"]').remove();
$('#single_designee option[value="1288"]').remove();
$('#single_designee option[value="1461"]').remove();
$('#single_designee option[value="1321"]').remove();
$('#single_designee option[value="1052"]').remove();
$('#single_designee option[value="1056"]').remove();
$('#single_designee option[value="1054"]').remove();
$('#single_designee option[value="1682"]').remove();
$('#single_designee option[value="1683"]').remove();
$('#single_designee option[value="1403"]').remove();
$('#single_designee option[value="1721"]').remove();
$('#single_designee option[value="1722"]').remove();
$('#single_designee option[value="1701"]').show();
$('#single_designee option[value="1561"]').remove();
$('#single_designee option[value="1061"]').show();
$('#single_designee').val('1001');
} else {
designeePick();
}
function getUrlVariable() {
var vars = [],
hash;
var hashes = window.location.href.slice(window.location.href.indexOf('?') + 1).split('&');
for (var i = 0; i < hashes.length; i++) {
hash = hashes[i].split('=');
vars.push(hash[0]);
vars[hash[0]] = hash[1];
}
return vars;
}
var fund_option = getUrlVariable()["fund_option"];
var appeal = getUrlVariable()["appeal"];
var segment = getUrlVariable()["segment"];
if (fund_option == "jwch") {
$('#single_designee').val('1701');
} else if (fund_option == "hcc") {
$('#single_designee').val('1061');
} else if (fund_option == "gcsom") {
$('#single_designee').val('1401');
} else if (fund_option == "take_a_seat") {
$('#single_designee').val('1682');
$('#single_designee').trigger('change');
} else if (fund_option == "behavioral_health") {
$('#single_designee').val('1683');
$('#single_designee').trigger('change');
} else if (appeal == "child_life") {
$('#appeal_descriptionhidden').val("AG - CY 2021 Holiday Child Life Mailing");
//End of Year Email Campaign Email #1: Thanksgiving Email
} else if (appeal == "AG21EOYE1" && segment == "FTD") {
$('#appeal_descriptionhidden').val("AG - CY 2021 EOY Email: Thanksgiving Email");
$('#package_descriptionhidden').val('First Time Donor');
$("#level_standardexpanded2565").prop("checked", true).trigger("click");
$(".amtmonies").text("500");
$('#single_designee').val('1001');
$('#single_designee option[value="1561"]').remove();
} else if (appeal == "AG21EOYE1" && segment == "LD") {
$('#appeal_descriptionhidden').val("AG - CY 2021 EOY Email: Thanksgiving Email");
$('#package_descriptionhidden').val('Lapsed Donor');
$("#level_standardexpanded2262").prop("checked", true).trigger("click");
$(".amtmonies").text("250");
$('#single_designee').val('1001');
$('#single_designee option[value="1561"]').remove();
} else if (appeal == "AG21EOYE1" && segment == "ND") {
$('#appeal_descriptionhidden').val("AG - CY 2021 EOY Email: Thanksgiving Email");
$('#package_descriptionhidden').val('Non-Donor');
$("#level_standardexpanded2262").prop("checked", true).trigger("click");
$(".amtmonies").text("250");
$('#single_designee').val('1001');
$('#single_designee option[value="1561"]').remove();
} else if (appeal == "AG21EOYE1" && segment == "P") {
$('#appeal_descriptionhidden').val("AG - CY 2021 EOY Email: Thanksgiving Email");
$('#package_descriptionhidden').val('Patient');
$("#level_standardexpanded2262").prop("checked", true).trigger("click");
$(".amtmonies").text("250");
$('#single_designee').val('1001');
$('#single_designee option[value="1561"]').remove();
//End of Year Email Campaign Email #2: Pre #GivingTuesday Solicitation Email
} else if (appeal == "AG21EOYE2" && segment == "ED") {
$('#appeal_descriptionhidden').val("AG - CY 2021 EOY Email: Pre #GivingTuesday Solicitation Email");
$('#package_descriptionhidden').val('Employee Donor');
$("#level_standardexpanded2261").prop("checked", true).trigger("click");
$(".amtmonies").text("100");
$('#single_designee').val('1561');
$('#single_designee option[value="1561"]').show();
} else if (appeal == "AG21EOYE2" && segment == "FTD") {
$('#appeal_descriptionhidden').val("AG - CY 2021 EOY Email: Pre #GivingTuesday Solicitation Email");
$('#package_descriptionhidden').val('First Time Donor');
$("#level_standardexpanded2565").prop("checked", true).trigger("click");
$(".amtmonies").text("500");
$('#single_designee').val('1001');
$('#single_designee option[value="1561"]').remove();
} else if (appeal == "AG21EOYE2" && segment == "LD") {
$('#appeal_descriptionhidden').val("AG - CY 2021 EOY Email: Pre #GivingTuesday Solicitation Email");
$('#package_descriptionhidden').val('Lapsed Donor');
$("#level_standardexpanded2262").prop("checked", true).trigger("click");
$(".amtmonies").text("250");
$('#single_designee').val('1001');
$('#single_designee option[value="1561"]').remove();
} else if (appeal == "AG21EOYE2" && segment == "ND") {
$('#appeal_descriptionhidden').val("AG - CY 2021 EOY Email: Pre #GivingTuesday Solicitation Email");
$('#package_descriptionhidden').val('Non-Donor');
$("#level_standardexpanded2262").prop("checked", true).trigger("click");
$(".amtmonies").text("250");
$('#single_designee').val('1001');
$('#single_designee option[value="1561"]').remove();
} else if (appeal == "AG21EOYE2" && segment == "P") {
$('#appeal_descriptionhidden').val("AG - CY 2021 EOY Email: Pre #GivingTuesday Solicitation Email");
$('#package_descriptionhidden').val('Patient');
$("#level_standardexpanded2262").prop("checked", true).trigger("click");
$(".amtmonies").text("250");
$('#single_designee').val('1001');
$('#single_designee option[value="1561"]').remove();
//End of Year Email Campaign Email #3: #GivingTuesday Solicitation Email
} else if (appeal == "AG21EOYE3" && segment == "ED") {
$('#appeal_descriptionhidden').val("AG - CY 2021 EOY Email: #GivingTuesday Solicitation Email");
$('#package_descriptionhidden').val('Employee Donor');
$("#level_standardexpanded2261").prop("checked", true).trigger("click");
$(".amtmonies").text("100");
$('#single_designee').val('1561');
$('#single_designee option[value="1561"]').show();
} else if (appeal == "AG21EOYE3" && segment == "FTD") {
$('#appeal_descriptionhidden').val("AG - CY 2021 EOY Email: #GivingTuesday Solicitation Email");
$('#package_descriptionhidden').val('First Time Donor');
$("#level_standardexpanded2565").prop("checked", true).trigger("click");
$(".amtmonies").text("500");
$('#single_designee').val('1001');
$('#single_designee option[value="1561"]').remove();
} else if (appeal == "AG21EOYE3" && segment == "LD") {
$('#appeal_descriptionhidden').val("AG - CY 2021 EOY Email: #GivingTuesday Solicitation Email");
$('#package_descriptionhidden').val('Lapsed Donor');
$("#level_standardexpanded2262").prop("checked", true).trigger("click");
$(".amtmonies").text("250");
$('#single_designee').val('1001');
$('#single_designee option[value="1561"]').remove();
} else if (appeal == "AG21EOYE3" && segment == "ND") {
$('#appeal_descriptionhidden').val("AG - CY 2021 EOY Email: #GivingTuesday Solicitation Email");
$('#package_descriptionhidden').val('Non-Donor');
$("#level_standardexpanded2262").prop("checked", true).trigger("click");
$(".amtmonies").text("250");
$('#single_designee').val('1001');
$('#single_designee option[value="1561"]').remove();
} else if (appeal == "AG21EOYE3" && segment == "P") {
$('#appeal_descriptionhidden').val("AG - CY 2021 EOY Email: #GivingTuesday Solicitation Email");
$('#package_descriptionhidden').val('Patient');
$("#level_standardexpanded2262").prop("checked", true).trigger("click");
$(".amtmonies").text("250");
$('#single_designee').val('1001');
$('#single_designee option[value="1561"]').remove();
//End of Year Email Campaign Email #4: GCSOM Solicitation Email
} else if (appeal == "AG21EOYE4" && segment == "GCSOMD") {
$('#appeal_descriptionhidden').val("AG - CY 2021 EOY Email: GCSOM Solicitation Email");
$('#package_descriptionhidden').val('GCSOM Donor');
$("#level_standardexpanded2566").prop("checked", true).trigger("click");
$(".amtmonies").text("1,000");
$('#single_designee').val('1401');
$('#single_designee option[value="1561"]').show();
} else if (appeal == "AG21EOYE4" && segment == "GHSP") {
$('#appeal_descriptionhidden').val("AG - CY 2021 EOY Email: GCSOM Solicitation Email");
$('#package_descriptionhidden').val('GHS Physician');
$("#level_standardexpanded2566").prop("checked", true).trigger("click");
$(".amtmonies").text("1,000");
$('#single_designee').val('1401');
$('#single_designee option[value="1561"]').remove();
} else if (appeal == "AG21EOYE4" && segment == "GCSOMA") {
$('#appeal_descriptionhidden').val("AG - CY 2021 EOY Email: GCSOM Solicitation Email");
$('#package_descriptionhidden').val('GCSOM Alumni');
$("#level_standardexpanded2566").prop("checked", true).trigger("click");
$(".amtmonies").text("1,000");
$('#single_designee').val('1401');
$('#single_designee option[value="1561"]').remove();
} else if (appeal == "AG21EOYE4" && segment == "GCSOMP") {
$('#appeal_descriptionhidden').val("AG - CY 2021 EOY Email: GCSOM Solicitation Email");
$('#package_descriptionhidden').val('GCSOM Parent');
$("#level_standardexpanded2566").prop("checked", true).trigger("click");
$(".amtmonies").text("1,000");
$('#single_designee').val('1401');
$('#single_designee option[value="1561"]').remove();
} else if (appeal == "AG21EOYE4" && segment == "LGCSOMP") {
$('#appeal_descriptionhidden').val("AG - CY 2021 EOY Email: GCSOM Solicitation Email");
$('#package_descriptionhidden').val('Look-a-like GCSOM Prospect');
$("#level_standardexpanded2565").prop("checked", true).trigger("click");
$(".amtmonies").text("500");
$('#single_designee').val('1401');
$('#single_designee option[value="1561"]').remove();
} else if (appeal == "AG21EOYE4" && segment == "D") {
$('#appeal_descriptionhidden').val("AG - CY 2021 EOY Email: GCSOM Solicitation Email");
$('#package_descriptionhidden').val('Donor');
$("#level_standardexpanded2565").prop("checked", true).trigger("click");
$(".amtmonies").text("500");
$('#single_designee').val('1401');
$('#single_designee option[value="1561"]').remove();
} else if (appeal == "AG21EOYE4" && segment == "ND") {
$('#appeal_descriptionhidden').val("AG - CY 2021 EOY Email: GCSOM Solicitation Email");
$('#package_descriptionhidden').val('Non-Donor');
$("#level_standardexpanded2262").prop("checked", true).trigger("click");
$(".amtmonies").text("250");
$('#single_designee').val('1401');
$('#single_designee option[value="1561"]').remove();
} else if (appeal == "AG21EOYE4" && segment == "P") {
$('#appeal_descriptionhidden').val("AG - CY 2021 EOY Email: GCSOM Solicitation Email");
$('#package_descriptionhidden').val('Patient');
$("#level_standardexpanded2262").prop("checked", true).trigger("click");
$(".amtmonies").text("250");
$('#single_designee').val('1401');
$('#single_designee option[value="1561"]').remove();
//End of Year Email Campaign Email #5: HCC Solicitation Email
} else if (appeal == "AG21EOYE5" && segment == "HCCDon250") {
$('#appeal_descriptionhidden').val("AG - CY 2021 EOY Email: HCC Solicitation Email");
$('#package_descriptionhidden').val('HCC Donor - 250');
$("#level_standardexpanded2262").prop("checked", true).trigger("click");
$(".amtmonies").text("250");
$('#single_designee').val('1061');
$('#single_designee option[value="1561"]').remove();
} else if (appeal == "AG21EOYE5" && segment == "HCCDon500") {
$('#appeal_descriptionhidden').val("AG - CY 2021 EOY Email: HCC Solicitation Email");
$('#package_descriptionhidden').val('HCC Donor - 500');
$("#level_standardexpanded2565").prop("checked", true).trigger("click");
$(".amtmonies").text("500");
$('#single_designee').val('1061');
$('#single_designee option[value="1561"]').remove();
} else if (appeal == "AG21EOYE5" && segment == "HCCDon1000") {
$('#appeal_descriptionhidden').val("AG - CY 2021 EOY Email: HCC Solicitation Email");
$('#package_descriptionhidden').val('HCC Donor - 1000');
$("#level_standardexpanded2566").prop("checked", true).trigger("click");
$(".amtmonies").text("1,000");
$('#single_designee').val('1061');
$('#single_designee option[value="1561"]').remove();
} else if (appeal == "AG21EOYE5" && segment == "LHCCP") {
$('#appeal_descriptionhidden').val("AG - CY 2021 EOY Email: HCC Solicitation Email");
$('#package_descriptionhidden').val('Look-a-like HCC Prospect');
$("#level_standardexpanded2565").prop("checked", true).trigger("click");
$(".amtmonies").text("500");
$('#single_designee').val('1061');
$('#single_designee option[value="1561"]').remove();
} else if (appeal == "AG21EOYE5" && segment == "D") {
$('#appeal_descriptionhidden').val("AG - CY 2021 EOY Email: HCC Solicitation Email");
$('#package_descriptionhidden').val('Donor');
$("#level_standardexpanded2565").prop("checked", true).trigger("click");
$(".amtmonies").text("500");
$('#single_designee').val('1061');
$('#single_designee option[value="1561"]').remove();
} else if (appeal == "AG21EOYE5" && segment == "ND") {
$('#appeal_descriptionhidden').val("AG - CY 2021 EOY Email: HCC Solicitation Email");
$('#package_descriptionhidden').val('Non-Donor');
$("#level_standardexpanded2262").prop("checked", true).trigger("click");
$(".amtmonies").text("250");
$('#single_designee').val('1061');
$('#single_designee option[value="1561"]').remove();
} else if (appeal == "AG21EOYE5" && segment == "P") {
$('#appeal_descriptionhidden').val("AG - CY 2021 EOY Email: HCC Solicitation Email");
$('#package_descriptionhidden').val('Patient');
$("#level_standardexpanded2262").prop("checked", true).trigger("click");
$(".amtmonies").text("250");
$('#single_designee').val('1061');
$('#single_designee option[value="1561"]').remove();
//End of Year Email Campaign Email #6: Unrestricated Fund Solicitation Email
} else if (appeal == "AG21EOYE6" && segment == "ED") {
$('#appeal_descriptionhidden').val("AG - CY 2021 EOY Email: Unrestricted Fund Solicitation Email");
$('#package_descriptionhidden').val('Employee Donor');
$("#level_standardexpanded2261").prop("checked", true).trigger("click");
$(".amtmonies").text("100");
$('#single_designee').val('1561');
$('#single_designee option[value="1561"]').show();
} else if (appeal == "AG21EOYE6" && segment == "FTD") {
$('#appeal_descriptionhidden').val("AG - CY 2021 EOY Email: Unrestricted Fund Solicitation Email");
$('#package_descriptionhidden').val('First Time Donor');
$("#level_standardexpanded2565").prop("checked", true).trigger("click");
$(".amtmonies").text("500");
$('#single_designee').val('1001');
$('#single_designee option[value="1561"]').remove();
} else if (appeal == "AG21EOYE6" && segment == "LD") {
$('#appeal_descriptionhidden').val("AG - CY 2021 EOY Email: Unrestricted Fund Solicitation Email");
$('#package_descriptionhidden').val('Lapsed Donor');
$("#level_standardexpanded2262").prop("checked", true).trigger("click");
$(".amtmonies").text("250");
$('#single_designee').val('1001');
$('#single_designee option[value="1561"]').remove();
} else if (appeal == "AG21EOYE6" && segment == "ND") {
$('#appeal_descriptionhidden').val("AG - CY 2021 EOY Email: Unrestricted Fund Solicitation Email");
$('#package_descriptionhidden').val('Non-Donor');
$("#level_standardexpanded2262").prop("checked", true).trigger("click");
$(".amtmonies").text("250");
$('#single_designee').val('1001');
$('#single_designee option[value="1561"]').remove();
} else if (appeal == "AG21EOYE6" && segment == "P") {
$('#appeal_descriptionhidden').val("AG - CY 2021 EOY Email: Unrestricted Fund Solicitation Email");
$('#package_descriptionhidden').val('Patient');
$("#level_standardexpanded2262").prop("checked", true).trigger("click");
$(".amtmonies").text("250");
$('#single_designee').val('1001');
$('#single_designee option[value="1561"]').remove();
//End of Year Email Campaign Email #6: GCSOM Alumni Solicitation Email
} else if (appeal == "AG21EOYE6Alum" && segment == "A1") {
$('#appeal_descriptionhidden').val("AG - CY 2021 EOY Email: GCSOM Alumni Solicitation Email");
$('#package_descriptionhidden').val('Class of 2013');
$("#level_standardexpanded2262").prop("checked", true).trigger("click");
$(".amtmonies").text("250");
$('#single_designee').val('1401');
$('#single_designee option[value="1561"]').remove();
} else if (appeal == "AG21EOYE6Alum" && segment == "A2") {
$('#appeal_descriptionhidden').val("AG - CY 2021 EOY Email: GCSOM Alumni Solicitation Email");
$('#package_descriptionhidden').val('Remaining Alumni');
$("#level_standardexpanded2562").prop("checked", true).trigger("click");
$(".amtmonies").text("250");
$('#single_designee').val('1401');
$('#single_designee option[value="1561"]').remove();
//End of Year Email Campaign Email #7: JWCH Solicitation Email
} else if (appeal == "AG21EOYE7" && segment == "CWHDon250") {
$('#appeal_descriptionhidden').val("AG - CY 2021 EOY Email: JWCH Solicitation Email");
$('#package_descriptionhidden').val('CWH Donor - 250');
$("#level_standardexpanded2262").prop("checked", true).trigger("click");
$(".amtmonies").text("250");
$('#single_designee').val('1701');
$('#single_designee option[value="1561"]').remove();
} else if (appeal == "AG21EOYE7" && segment == "CWHDon500") {
$('#appeal_descriptionhidden').val("AG - CY 2021 EOY Email: JWCH Solicitation Email");
$('#package_descriptionhidden').val('CWH Donor - 500');
$("#level_standardexpanded2565").prop("checked", true).trigger("click");
$(".amtmonies").text("500");
$('#single_designee').val('1701');
$('#single_designee option[value="1561"]').remove();
} else if (appeal == "AG21EOYE7" && segment == "CWHDon1000") {
$('#appeal_descriptionhidden').val("AG - CY 2021 EOY Email: JWCH Solicitation Email");
$('#package_descriptionhidden').val('CWH Donor - 1000');
$("#level_standardexpanded2566").prop("checked", true).trigger("click");
$(".amtmonies").text("1,000");
$('#single_designee').val('1701');
$('#single_designee option[value="1561"]').remove();
} else if (appeal == "AG21EOYE7" && segment == "LJWCHP") {
$('#appeal_descriptionhidden').val("AG - CY 2021 EOY Email: JWCH Solicitation Email");
$('#package_descriptionhidden').val('Look-a-like JWCH Prospect');
$("#level_standardexpanded2565").prop("checked", true).trigger("click");
$(".amtmonies").text("500");
$('#single_designee').val('1701');
$('#single_designee option[value="1561"]').remove();
} else if (appeal == "AG21EOYE7" && segment == "D") {
$('#appeal_descriptionhidden').val("AG - CY 2021 EOY Email: JWCH Solicitation Email");
$('#package_descriptionhidden').val('Donor');
$("#level_standardexpanded2565").prop("checked", true).trigger("click");
$(".amtmonies").text("500");
$('#single_designee').val('1701');
$('#single_designee option[value="1561"]').remove();
} else if (appeal == "AG21EOYE7" && segment == "ND") {
$('#appeal_descriptionhidden').val("AG - CY 2021 EOY Email: JWCH Solicitation Email");
$('#package_descriptionhidden').val('Non-Donor');
$("#level_standardexpanded2262").prop("checked", true).trigger("click");
$(".amtmonies").text("250");
$('#single_designee').val('1701');
$('#single_designee option[value="1561"]').remove();
} else if (appeal == "AG21EOYE7" && segment == "P") {
$('#appeal_descriptionhidden').val("AG - CY 2021 EOY Email: JWCH Solicitation Email");
$('#package_descriptionhidden').val('Patient');
$("#level_standardexpanded2262").prop("checked", true).trigger("click");
$(".amtmonies").text("250");
$('#single_designee').val('1701');
$('#single_designee option[value="1561"]').remove();
//End of Year Email Campaign Email #8: Final 48 Hours Solicitation Email
} else if (appeal == "AG21EOYE8" && segment == "ED") {
$('#appeal_descriptionhidden').val("AG - CY 2021 EOY Email: Final 48 Hours Solicitation Email");
$('#package_descriptionhidden').val('Employee Donor');
$("#level_standardexpanded2261").prop("checked", true).trigger("click");
$(".amtmonies").text("100");
$('#single_designee').val('1561');
$('#single_designee option[value="1561"]').show();
} else if (appeal == "AG21EOYE8" && segment == "FTD") {
$('#appeal_descriptionhidden').val("AG - CY 2021 EOY Email: Final 48 Hours Solicitation Email");
$('#package_descriptionhidden').val('First Time Donor');
$("#level_standardexpanded2565").prop("checked", true).trigger("click");
$(".amtmonies").text("500");
$('#single_designee').val('1001');
$('#single_designee option[value="1561"]').remove();
} else if (appeal == "AG21EOYE8" && segment == "LD") {
$('#appeal_descriptionhidden').val("AG - CY 2021 EOY Email: Final 48 Hours Solicitation Email");
$('#package_descriptionhidden').val('Lapsed Donor');
$("#level_standardexpanded2262").prop("checked", true).trigger("click");
$(".amtmonies").text("250");
$('#single_designee').val('1001');
$('#single_designee option[value="1561"]').remove();
} else if (appeal == "AG21EOYE8" && segment == "ND") {
$('#appeal_descriptionhidden').val("AG - CY 2021 EOY Email: Final 48 Hours Solicitation Email");
$('#package_descriptionhidden').val('Non-Donor');
$("#level_standardexpanded2262").prop("checked", true).trigger("click");
$(".amtmonies").text("250");
$('#single_designee').val('1001');
$('#single_designee option[value="1561"]').remove();
} else if (appeal == "AG21EOYE8" && segment == "P") {
$('#appeal_descriptionhidden').val("AG - CY 2021 EOY Email: Final 48 Hours Solicitation Email");
$('#package_descriptionhidden').val('Patient');
$("#level_standardexpanded2262").prop("checked", true).trigger("click");
$(".amtmonies").text("250");
$('#single_designee').val('1001');
$('#single_designee option[value="1561"]').remove();
//End of Year Email Campaign Email #9: Final 24 Hours Solicitation Email
} else if (appeal == "AG21EOYE9" && segment == "ED") {
$('#appeal_descriptionhidden').val("AG - CY 2021 EOY Email: Final 24 Hours Solicitation Email");
$('#package_descriptionhidden').val('Employee Donor');
$("#level_standardexpanded2261").prop("checked", true).trigger("click");
$(".amtmonies").text("100");
$('#single_designee').val('1561');
$('#single_designee option[value="1561"]').show();
} else if (appeal == "AG21EOYE9" && segment == "FTD") {
$('#appeal_descriptionhidden').val("AG - CY 2021 EOY Email: Final 24 Hours Solicitation Email");
$('#package_descriptionhidden').val('First Time Donor');
$("#level_standardexpanded2565").prop("checked", true).trigger("click");
$(".amtmonies").text("500");
$('#single_designee').val('1001');
$('#single_designee option[value="1561"]').remove();
} else if (appeal == "AG21EOYE9" && segment == "LD") {
$('#appeal_descriptionhidden').val("AG - CY 2021 EOY Email: Final 24 Hours Solicitation Email");
$('#package_descriptionhidden').val('Lapsed Donor');
$("#level_standardexpanded2262").prop("checked", true).trigger("click");
$(".amtmonies").text("250");
$('#single_designee').val('1001');
$('#single_designee option[value="1561"]').remove();
} else if (appeal == "AG21EOYE9" && segment == "ND") {
$('#appeal_descriptionhidden').val("AG - CY 2021 EOY Email: Final 24 Hours Solicitation Email");
$('#package_descriptionhidden').val('Non-Donor');
$("#level_standardexpanded2262").prop("checked", true).trigger("click");
$(".amtmonies").text("250");
$('#single_designee').val('1001');
$('#single_designee option[value="1561"]').remove();
} else if (appeal == "AG21EOYE9" && segment == "P") {
$('#appeal_descriptionhidden').val("AG - CY 2021 EOY Email: Final 24 Hours Solicitation Email");
$('#package_descriptionhidden').val('Patient');
$("#level_standardexpanded2262").prop("checked", true).trigger("click");
$(".amtmonies").text("250");
$('#single_designee').val('1001');
$('#single_designee option[value="1561"]').remove();
//End of Year Email Campaign Social Media Posts
} else if (appeal == "AG21EOYSM") {
$('#appeal_descriptionhidden').val("AG - CY 2021 EOY Social Media");
$("#level_standardexpanded2262").prop("checked", true).trigger("click");
$(".amtmonies").text("250");
$('#single_designee').val('1001');
$('#single_designee option[value="1561"]').remove();
} else {
designeePick();
}
});
$(document).ready(function() {
var CurrentDate = new Date();
GivenDate = new Date(2020, 11, 01);
var str = $("#package_descriptionhidden").val();
//alert(formatDate(CurrentDate) + " " + formatDate(GivenDate));
if (formatDate(GivenDate) == formatDate(CurrentDate) && $('#package_descriptionhidden').val().length > 1) {
$('#package_descriptionhidden').val('#GivingTuesday - ' + str);
} else {
$('#package_descriptionhidden').val(str);
}
});
function formatDate(date) {
var d = new Date(date),
month = '' + (d.getMonth() + 1),
day = '' + d.getDate(),
year = d.getFullYear();
if (month.length < 2) month = '0' + month;
if (day.length < 2) day = '0' + day;
return [year, month, day].join('-');
}
</script>
<p></p>
<style type="text/css">
<!--
@media only screen and (min-device-width: 320px) and (max-device-width: 568px) and (orientation: portrait) {
div.donation-level-container {
margin-left: 0px !important;
}
}
/* Landscape - Mobile Phones*/
@media only screen
/*and (min-device-width: 568px)*/
and (max-device-width: 846px) and (orientation: landscape) {
.don-standard-levels {
width: 70%;
!important;
}
}
-->
</style>
</div>
</div>
<div class="don-standard-levels form-row">
<div class="levels-label">
</div>
<div id="level_standard_row" class="form-row form-donation-level">
<div class="form-content">
<span class="field-required"></span> <span class="aural-only">Field Is Required</span>
<span class="FormLabelText">Donate to Geisinger Health Foundation</span>
<div class="donation-level-general-ask">
</div>
<div class="donation-levels">
<div class="donation-level-container">
<div class="form-content">
<div class="donation-level-input-container form-input">
<div class="donation-level-label-input-container">
<input type="radio" name="level_standardexpanded" id="level_standardexpanded2266" value="2266" onclick="evalMatchingGift('');
updateDonorCoverAmount('');">
</div>
<label for="level_standardexpanded2266" onclick="">
<div class="donation-level-label-container"> $25 </div>
</label>
</div>
<input type="hidden" name="level_standardexpandedsubmit" id="level_standard_2266expandedsubmit" value="true">
</div>
</div>
<div class="donation-level-container">
<div class="form-content">
<div class="donation-level-input-container form-input">
<div class="donation-level-label-input-container">
<input type="radio" name="level_standardexpanded" id="level_standardexpanded2267" value="2267" onclick="evalMatchingGift('');
updateDonorCoverAmount('');">
</div>
<label for="level_standardexpanded2267" onclick="">
<div class="donation-level-label-container"> $50 </div>
</label>
</div>
<input type="hidden" name="level_standardexpandedsubmit" id="level_standard_2267expandedsubmit" value="true">
</div>
</div>
<div class="donation-level-container">
<div class="form-content">
<div class="donation-level-input-container form-input">
<div class="donation-level-label-input-container">
<input type="radio" name="level_standardexpanded" id="level_standardexpanded2268" value="2268" onclick="evalMatchingGift('');
updateDonorCoverAmount('');">
</div>
<label for="level_standardexpanded2268" onclick="">
<div class="donation-level-label-container"> $75 </div>
</label>
</div>
<input type="hidden" name="level_standardexpandedsubmit" id="level_standard_2268expandedsubmit" value="true">
</div>
</div>
<div class="donation-level-container">
<div class="form-content">
<div class="donation-level-input-container form-input">
<div class="donation-level-label-input-container">
<input type="radio" name="level_standardexpanded" id="level_standardexpanded2261" value="2261" onclick="evalMatchingGift('');
updateDonorCoverAmount('');">
</div>
<label for="level_standardexpanded2261" onclick="">
<div class="donation-level-label-container"> $100 </div>
</label>
</div>
<input type="hidden" name="level_standardexpandedsubmit" id="level_standard_2261expandedsubmit" value="true">
</div>
</div>
<div class="donation-level-container">
<div class="form-content active">
<div class="donation-level-input-container form-input">
<div class="donation-level-label-input-container">
<input type="radio" name="level_standardexpanded" id="level_standardexpanded2262" value="2262" checked="checked" onclick="evalMatchingGift('');
updateDonorCoverAmount('');">
</div>
<label for="level_standardexpanded2262" onclick="">
<div class="donation-level-label-container"> $250 </div>
</label>
</div>
<input type="hidden" name="level_standardexpandedsubmit" id="level_standard_2262expandedsubmit" value="true">
</div>
</div>
<div class="donation-level-container">
<div class="form-content">
<div class="donation-level-input-container form-input">
<div class="donation-level-label-input-container">
<input type="radio" name="level_standardexpanded" id="level_standardexpanded2565" value="2565" onclick="evalMatchingGift('');
updateDonorCoverAmount('');">
</div>
<label for="level_standardexpanded2565" onclick="">
<div class="donation-level-label-container"> $500 </div>
</label>
</div>
<input type="hidden" name="level_standardexpandedsubmit" id="level_standard_2565expandedsubmit" value="true">
</div>
</div>
<div class="donation-level-container" style="display: none;">
<div class="form-content">
<div class="donation-level-input-container form-input">
<div class="donation-level-label-input-container">
<input type="radio" name="level_standardexpanded" id="level_standardexpanded2941" value="2941" onclick="evalMatchingGift('');
updateDonorCoverAmount('');">
</div>
<label for="level_standardexpanded2941" onclick="">
<div class="donation-level-label-container"> $750 </div>
</label>
</div>
<input type="hidden" name="level_standardexpandedsubmit" id="level_standard_2941expandedsubmit" value="true">
</div>
</div>
<div class="donation-level-container">
<div class="form-content">
<div class="donation-level-input-container form-input">
<div class="donation-level-label-input-container">
<input type="radio" name="level_standardexpanded" id="level_standardexpanded2566" value="2566" onclick="evalMatchingGift('');
updateDonorCoverAmount('');">
</div>
<label for="level_standardexpanded2566" onclick="">
<div class="donation-level-label-container"> $1,000 </div>
</label>
</div>
<input type="hidden" name="level_standardexpandedsubmit" id="level_standard_2566expandedsubmit" value="true">
</div>
</div>
<div class="donation-level-container">
<div class="form-content">
<div class="donation-level-input-container form-input">
<div class="donation-level-label-input-container">
<input type="radio" name="level_standardexpanded" id="level_standardexpanded2567" value="2567" onclick="evalMatchingGift('');
updateDonorCoverAmount('');">
</div>
<label for="level_standardexpanded2567" onclick="">
<div class="donation-level-label-container"> $5,000 </div>
</label>
</div>
<input type="hidden" name="level_standardexpandedsubmit" id="level_standard_2567expandedsubmit" value="true">
</div>
</div>
<div class="donation-level-container">
<div class="form-content">
<div class="donation-level-input-container form-input">
<div class="donation-level-label-input-container">
<input type="radio" name="level_standardexpanded" id="level_standardexpanded2263" value="2263" onclick="evalMatchingGift(document.getElementById('level_standardexpanded2263amount').value);
updateDonorCoverAmount(document.getElementById('level_standardexpanded2263amount').value);">
</div>
<label for="level_standardexpanded2263" onclick="">
<div class="donation-level-label-container"> Enter Amount </div>
</label>
<div class="donation-level-user-entered">
<label for="level_standardexpanded2263amount"><span class="aural-only">Enter amount</span></label>
<input type="text" name="level_standardexpanded2263amount" id="level_standardexpanded2263amount" value="" size="12"
onfocus="var el = document.getElementById ('level_standardexpanded2263');if (el) el.click(); fire_obs_comp_event('level_standardexpanded2263amount', this, event);evalMatchingGift(value); "
onchange="fire_obs_comp_event('level_standardexpanded2263amount', this, event);evalMatchingGift(value);" onkeyup="fire_obs_comp_event('level_standardexpanded2263amount', this, event);evalMatchingGift(value);"
onblur="fire_obs_comp_event('level_standardexpanded2263amount', this);updateDonorCoverAmount(value);" placeholder="Other">
</div>
</div>
<input type="hidden" name="level_standardexpandedsubmit" id="level_standard_2263expandedsubmit" value="true">
</div>
</div>
<div class="donation-level-container" style="display: none;">
<div class="form-content">
<div class="donation-level-input-container form-input">
<div class="donation-level-label-input-container">
<input type="radio" name="level_standardexpanded" id="level_standardexpanded2923" value="2923" onclick="evalMatchingGift(document.getElementById('level_standardexpanded2923amount').value);
updateDonorCoverAmount(document.getElementById('level_standardexpanded2923amount').value);">
</div>
<label for="level_standardexpanded2923" onclick="">
<div class="donation-level-label-container"> Donor Entered Amount </div>
</label>
<div class="donation-level-user-entered">
<label for="level_standardexpanded2923amount"><span class="aural-only">Enter amount</span></label>
<input type="text" name="level_standardexpanded2923amount" id="level_standardexpanded2923amount" value="" size="12"
onfocus="var el = document.getElementById ('level_standardexpanded2923');if (el) el.click(); fire_obs_comp_event('level_standardexpanded2923amount', this, event);evalMatchingGift(value); "
onchange="fire_obs_comp_event('level_standardexpanded2923amount', this, event);evalMatchingGift(value);" onkeyup="fire_obs_comp_event('level_standardexpanded2923amount', this, event);evalMatchingGift(value);"
onblur="fire_obs_comp_event('level_standardexpanded2923amount', this);updateDonorCoverAmount(value);" placeholder="Other">
</div>
</div>
<input type="hidden" name="level_standardexpandedsubmit" id="level_standard_2923expandedsubmit" value="true">
</div>
</div>
</div>
</div>
<script type="text/javascript">
Y.use("jquery-ui", function(Y) {
jQuery(function() {
// subscribe observables
jQuery('div.donation-level-element-container').find('input[type="radio"]').each(function() {
var syncAction = function(obj) {
if (obj.is(':checked')) {
obj.closest('div.donation-level-container').addClass('selected');
} else {
obj.closest('div.donation-level-container').removeClass('selected');
};
return arguments.callee;
}(jQuery(this));
jQuery(this).click(function() {
jQuery('div.donation-level-container').removeClass('selected');
syncAction(jQuery(this));
});
});
});
});
</script><noscript> </noscript>
</div>
<div class="levels-gift-aid">
</div>
<input type="hidden" name="level_standardsubmit" id="level_standardsubmit" value="true">
<script type="text/javascript">
function updateDonorCoverAmount(gift) {
if (typeof updateAmount !== "undefined") {
updateAmount(gift);
}
};
function evalMatchingGift(gift) {}
</script><noscript> </noscript>
</div>
<div id="single_designee_row" class="form-row form-designee">
<div class="form-content">
<fieldset>
<legend>
<span class="field-required"></span> <span class="aural-only">Field Is Required</span> Gift Designation:
</legend>
<div class="form-input">
<div class="designated-option">
<input type="radio" name="single_designee_radio" id="single_designee_designated" value="designated" onclick="single_designee_enable_list(this.checked);">
<label for="single_designee_designated">Direct my gift to:</label>
<select name="single_designee" id="single_designee" size="1">
<option value="1001">Health System Priorities</option>
<option value="1401">Geisinger Commonwealth School of Medicine Scholarships</option>
<option value="1061" style="display: block;">Henry Cancer Center at GWV</option>
<option value="1701" style="display: block;">Janet Weis Children's Hospital</option>
<option value="1099">Other</option>
</select><input type="text" name="other_fund_input" id="other_fund_input" value="" maxlength="255" style="display: none;" placeholder="Please Input Fund Designation">
<script type="text/javascript">
<!--
var comp = new ObservableComponent('single_designee', '');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('single_designee_Row', _display);
this.disable_submit_flag(_hidden);
}
//
-->
</script>
<noscript><br>Required</noscript>
</div>
</div>
</fieldset>
</div>
<input type="hidden" name="single_designeesubmit" id="single_designeesubmit" value="true">
<script type="text/javascript">
var sel_item = 0;
function single_designee_disable_list(_checked) {
if (_checked) {
var list = document.getElementById('single_designee');
if (list) {
list.disabled = true;
list[0].selected = true;
}
} else {
single_designee_enable_list(true);
}
}
function single_designee_enable_list(_checked) {
if (_checked) {
var list = document.getElementById('single_designee');
if (list) {
list.disabled = false;
}
} else {
single_designee_disable_list(true);
}
}
// When first radio is selected, disable the list by the second radio.
var el = document.getElementById('single_designee');
if (el) el.disabled = true;
var comp = new ObservableComponent('single_designee', '');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('single_designee_Row', _display);
this.disable_submit_flag(_hidden);
}
function single_designee_listChanged(_evt) {
var e = _evt ? _evt : event; // IE vs. Mozilla event model
if (e) {
var src = e.target ? e.target : e.srcElement; // IE vs. Mozilla event model
fire_obs_comp_event('single_designee', src);
}
}
var el = document.getElementById('single_designee');
if (el) {
Utils.addEvent(el, 'change', single_designee_listChanged);
}
</script><noscript> </noscript>
</div>
<div class="custom-field-container form-row ">
<div class="form-content">
<div class="form-input-label-block">
<label for="other_fund_input" style="display: none;">Direct my gift to:</label>
</div>
<input type="hidden" name="other_fundsubmit" id="other_fundsubmit" value="true">
</div>
</div>
<div class="donation-level-container-generic-repeat form-input">
<div class="generic-repeat-label-checkbox-container">
<input type="checkbox" name="level_standardauto_repeatname" id="level_standardauto_repeatname" onclick="fire_obs_comp_event('level_standardauto_repeat', this);" onkeypress="fire_obs_comp_event('level_standardauto_repeat', this);">
<label for="level_standardauto_repeatname"> Yes, repeat my gift monthly. </label>
</div>
<input type="hidden" name="level_standardauto_repeatsubmit" id="level_standardauto_repeatsubmit" value="true">
</div>
<input type="hidden" name="appeal_descriptionhidden" id="appeal_descriptionhidden" value="AG - CY 2021 EOY Email: Final 48 Hours Solicitation Email">
<input type="hidden" name="package_descriptionhidden" id="package_descriptionhidden" value="Patient">
<input type="hidden" name="campaign_descriptionhidden" id="campaign_descriptionhidden" value="">
<div id="tribute_show_honor_fields_row" class="form-row form-checkbox">
<div class="form-content">
<input type="checkbox" name="tribute_show_honor_fieldsname" id="tribute_show_honor_fieldsname" onclick="fire_obs_comp_event('tribute_show_honor_fields', this);">
<label for="tribute_show_honor_fieldsname">This is a memorial gift or in honor of someone.</label>
<input type="hidden" name="tribute_show_honor_fieldssubmit" id="tribute_show_honor_fieldssubmit" value="true">
<script type="text/javascript">
var comp = new ObservableComponent('tribute_show_honor_fields', 'name');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('tribute_show_honor_fields_row', _display);
this.disable_submit_flag(_hidden);
}
comp.set = function(_value) {
if (document.getElementById('tribute_show_honor_fieldsname')) {
document.getElementById('tribute_show_honor_fieldsname').checked = _value;
this.fireEvent();
}
}
comp.get = function() {
if (document.getElementById('tribute_show_honor_fieldsname')) {
return document.getElementById('tribute_show_honor_fieldsname').checked;
}
}
comp.clear = function() {
this.set(false);
}
</script><noscript> </noscript>
</div>
</div>
<div id="tribute_type_row" class="form-row form-selectlist" style="display: none;">
<div class="form-content">
<label class="FormLabel" for="tribute_type">Gift Type</label>
<select name="tribute_type" id="tribute_type" size="1">
<option></option>
<option value="tribute_type_value1">In Memory of</option>
<option value="tribute_type_value2">In Honor of</option>
</select>
<script type="text/javascript">
<!--
var comp = new ObservableComponent('tribute_type', '');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('tribute_type_Row', _display);
this.disable_submit_flag(_hidden);
}
//
-->
</script>
<noscript><br>Required</noscript>
<input type="hidden" name="tribute_typesubmit_skip" id="tribute_typesubmit" value="true">
<script type="text/javascript">
var comp = new ObservableComponent('tribute_type', '');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('tribute_type_row', _display);
this.disable_submit_flag(_hidden);
}
observe_component('tribute_show_honor_fields.true', new ComponentDisplayer('tribute_type'));
function tribute_type_listChanged(_evt) {
var e = _evt ? _evt : event; // IE vs. Mozilla event model
if (e) {
var src = e.target ? e.target : e.srcElement; // IE vs. Mozilla event model
fire_obs_comp_event('tribute_type', src);
}
}
var el = document.getElementById('tribute_type');
if (el) {
Utils.addEvent(el, 'change', tribute_type_listChanged);
}
</script><noscript> </noscript>
</div>
</div>
<div id="tribute_honoree_first_name_row" class="form-row form-text" style="display: none;">
<div class="form-content">
<span class="field-required"></span>
<label for="tribute_honoree_first_namename">Honoree First Name</label>
<input type="text" name="tribute_honoree_first_namename" id="tribute_honoree_first_namename" value="" maxlength="50">
<input type="hidden" name="tribute_honoree_first_namesubmit_skip" id="tribute_honoree_first_namesubmit" value="true">
<script type="text/javascript">
var comp = new ObservableComponent('tribute_honoree_first_name', 'name');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('tribute_honoree_first_name_row', _display);
this.disable_submit_flag(_hidden);
}
observe_component('tribute_show_honor_fields.true', new ComponentDisplayer('tribute_honoree_first_name'));
</script><noscript> </noscript>
</div>
</div>
<div id="tribute_honoree_last_name_row" class="form-row form-text" style="display: none;">
<div class="form-content">
<span class="field-required"></span>
<label for="tribute_honoree_last_namename">Honoree Last Name</label>
<input type="text" name="tribute_honoree_last_namename" id="tribute_honoree_last_namename" value="" maxlength="50">
<input type="hidden" name="tribute_honoree_last_namesubmit_skip" id="tribute_honoree_last_namesubmit" value="true">
<script type="text/javascript">
var comp = new ObservableComponent('tribute_honoree_last_name', 'name');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('tribute_honoree_last_name_row', _display);
this.disable_submit_flag(_hidden);
}
observe_component('tribute_show_honor_fields.true', new ComponentDisplayer('tribute_honoree_last_name'));
</script><noscript> </noscript>
</div>
</div>
<div id="honor-name" style="display: none; margin-top: 15px; font-weight: bold; font-style: italic; width: 100%; float: left;">Send gift notification to:</div>
<div id="tribute_notify_recip_name_row" class="form-row form-text" style="display: none;">
<div class="form-content">
<span class="field-required"></span>
<label for="tribute_notify_recip_namename">First Name</label>
<input type="text" name="tribute_notify_recip_namename" id="tribute_notify_recip_namename" value="" maxlength="70">
<input type="hidden" name="tribute_notify_recip_namesubmit_skip" id="tribute_notify_recip_namesubmit" value="true">
<script type="text/javascript">
var comp = new ObservableComponent('tribute_notify_recip_name', 'name');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('tribute_notify_recip_name_row', _display);
this.disable_submit_flag(_hidden);
}
observe_component('tribute_show_honor_fields.true', new ComponentDisplayer('tribute_notify_recip_name'));
</script><noscript> </noscript>
</div>
</div>
<div id="tribute_signature_row" class="form-row form-text" style="display: none;">
<div class="form-content">
<span class="field-required"></span>
<label for="tribute_signaturename">Last Name</label>
<input type="text" name="tribute_signaturename" id="tribute_signaturename" value="" maxlength="70">
<input type="hidden" name="tribute_signaturesubmit_skip" id="tribute_signaturesubmit" value="true">
<script type="text/javascript">
var comp = new ObservableComponent('tribute_signature', 'name');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('tribute_signature_row', _display);
this.disable_submit_flag(_hidden);
}
observe_component('tribute_show_honor_fields.true', new ComponentDisplayer('tribute_signature'));
</script><noscript> </noscript>
</div>
</div>
<div id="tribute_notify_recip_street1_row" class="form-row form-text" style="display: none;">
<div class="form-content">
<span class="field-required"></span>
<label for="tribute_notify_recip_street1name">Street 1</label>
<input type="text" name="tribute_notify_recip_street1name" id="tribute_notify_recip_street1name" value="" maxlength="50">
<input type="hidden" name="tribute_notify_recip_street1submit_skip" id="tribute_notify_recip_street1submit" value="true">
<script type="text/javascript">
var comp = new ObservableComponent('tribute_notify_recip_street1', 'name');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('tribute_notify_recip_street1_row', _display);
this.disable_submit_flag(_hidden);
}
observe_component('tribute_show_honor_fields.true', new ComponentDisplayer('tribute_notify_recip_street1'));
</script><noscript> </noscript>
</div>
</div>
<div id="tribute_notify_recip_street2_row" class="form-row form-text" style="display: none;">
<div class="form-content">
<label for="tribute_notify_recip_street2name">Street 2 (optional)</label>
<input type="text" name="tribute_notify_recip_street2name" id="tribute_notify_recip_street2name" value="" maxlength="50">
<input type="hidden" name="tribute_notify_recip_street2submit_skip" id="tribute_notify_recip_street2submit" value="true">
<script type="text/javascript">
var comp = new ObservableComponent('tribute_notify_recip_street2', 'name');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('tribute_notify_recip_street2_row', _display);
this.disable_submit_flag(_hidden);
}
observe_component('tribute_show_honor_fields.true', new ComponentDisplayer('tribute_notify_recip_street2'));
</script><noscript> </noscript>
</div>
</div>
<div id="tribute_notify_recip_city_row" class="form-row form-text" style="display: none;">
<div class="form-content">
<span class="field-required"></span>
<label for="tribute_notify_recip_cityname">City</label>
<input type="text" name="tribute_notify_recip_cityname" id="tribute_notify_recip_cityname" value="" maxlength="50">
<input type="hidden" name="tribute_notify_recip_citysubmit_skip" id="tribute_notify_recip_citysubmit" value="true">
<script type="text/javascript">
var comp = new ObservableComponent('tribute_notify_recip_city', 'name');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('tribute_notify_recip_city_row', _display);
this.disable_submit_flag(_hidden);
}
observe_component('tribute_show_honor_fields.true', new ComponentDisplayer('tribute_notify_recip_city'));
</script><noscript> </noscript>
</div>
</div>
<div id="tribute_notify_recip_state_row" class="form-row form-selectlist" style="display: none;">
<div class="form-content">
<span class="field-required"></span>
<label class="FormLabel" for="tribute_notify_recip_state">State/Province</label>
<select name="tribute_notify_recip_state" id="tribute_notify_recip_state" size="1" onchange="fire_obs_comp_event('tribute_notify_recip_state', this)">
<option></option>
<option value="AK">AK - Alaska</option>
<option value="AL">AL - Alabama</option>
<option value="AR">AR - Arkansas</option>
<option value="AZ">AZ - Arizona</option>
<option value="CA">CA - California</option>
<option value="CO">CO - Colorado</option>
<option value="CT">CT - Connecticut</option>
<option value="DC">DC - District of Columbia</option>
<option value="DE">DE - Delaware</option>
<option value="FL">FL - Florida</option>
<option value="GA">GA - Georgia</option>
<option value="HI">HI - Hawaii</option>
<option value="IA">IA - Iowa</option>
<option value="ID">ID - Idaho</option>
<option value="IL">IL - Illinois</option>
<option value="IN">IN - Indiana</option>
<option value="KS">KS - Kansas</option>
<option value="KY">KY - Kentucky</option>
<option value="LA">LA - Louisiana</option>
<option value="MA">MA - Massachusetts</option>
<option value="MD">MD - Maryland</option>
<option value="ME">ME - Maine</option>
<option value="MI">MI - Michigan</option>
<option value="MN">MN - Minnesota</option>
<option value="MO">MO - Missouri</option>
<option value="MS">MS - Mississippi</option>
<option value="MT">MT - Montana</option>
<option value="NC">NC - North Carolina</option>
<option value="ND">ND - North Dakota</option>
<option value="NE">NE - Nebraska</option>
<option value="NH">NH - New Hampshire</option>
<option value="NJ">NJ - New Jersey</option>
<option value="NM">NM - New Mexico</option>
<option value="NV">NV - Nevada</option>
<option value="NY">NY - New York</option>
<option value="OH">OH - Ohio</option>
<option value="OK">OK - Oklahoma</option>
<option value="OR">OR - Oregon</option>
<option value="PA">PA - Pennsylvania</option>
<option value="RI">RI - Rhode Island</option>
<option value="SC">SC - South Carolina</option>
<option value="SD">SD - South Dakota</option>
<option value="TN">TN - Tennessee</option>
<option value="TX">TX - Texas</option>
<option value="UT">UT - Utah</option>
<option value="VA">VA - Virginia</option>
<option value="VT">VT - Vermont</option>
<option value="WA">WA - Washington</option>
<option value="WI">WI - Wisconsin</option>
<option value="WV">WV - West Virginia</option>
<option value="WY">WY - Wyoming</option>
<option value="AS">AS - American Samoa</option>
<option value="FM">FM - Federated States of Micronesia</option>
<option value="GU">GU - Guam</option>
<option value="MH">MH - Marshall Islands</option>
<option value="MP">MP - Northern Mariana Islands</option>
<option value="PR">PR - Puerto Rico</option>
<option value="PW">PW - Palau</option>
<option value="VI">VI - Virgin Islands</option>
<option value="AA">AA - Armed Forces Americas</option>
<option value="AE">AE - Armed Forces</option>
<option value="AP">AP - Armed Forces Pacific</option>
<option value="AB">AB - Alberta</option>
<option value="BC">BC - British Columbia</option>
<option value="MB">MB - Manitoba</option>
<option value="NB">NB - New Brunswick</option>
<option value="NL">NL - Newfoundland and Labrador</option>
<option value="NS">NS - Nova Scotia</option>
<option value="NT">NT - Northwest Territories</option>
<option value="NU">NU - Nunavut</option>
<option value="ON">ON - Ontario</option>
<option value="PE">PE - Prince Edward Island</option>
<option value="QC">QC - Quebec</option>
<option value="SK">SK - Saskatchewan</option>
<option value="YT">YT - Yukon</option>
<option value="None">None</option>
</select>
<script type="text/javascript">
<!--
var comp = new ObservableComponent('tribute_notify_recip_state', '');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('tribute_notify_recip_state_Row', _display);
this.disable_submit_flag(_hidden);
}
//
-->
</script>
<noscript><br>Required</noscript>
<input type="hidden" name="tribute_notify_recip_statesubmit_skip" id="tribute_notify_recip_statesubmit" value="true">
<script type="text/javascript">
var comp = new ObservableComponent('tribute_notify_recip_state', '');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('tribute_notify_recip_state_row', _display);
this.disable_submit_flag(_hidden);
}
observe_component('tribute_show_honor_fields.true', new ComponentDisplayer('tribute_notify_recip_state'));
function tribute_notify_recip_state_listChanged(_evt) {
var e = _evt ? _evt : event; // IE vs. Mozilla event model
if (e) {
var src = e.target ? e.target : e.srcElement; // IE vs. Mozilla event model
fire_obs_comp_event('tribute_notify_recip_state', src);
}
}
var el = document.getElementById('tribute_notify_recip_state');
if (el) {
Utils.addEvent(el, 'change', tribute_notify_recip_state_listChanged);
}
</script><noscript> </noscript>
</div>
</div>
<div id="tribute_notify_recip_zip_row" class="form-row form-text" style="display: none;">
<div class="form-content">
<span class="field-required"></span>
<label for="tribute_notify_recip_zipname">ZIP Code</label>
<input type="text" name="tribute_notify_recip_zipname" id="tribute_notify_recip_zipname" value="" maxlength="50">
<input type="hidden" name="tribute_notify_recip_zipsubmit_skip" id="tribute_notify_recip_zipsubmit" value="true">
<script type="text/javascript">
var comp = new ObservableComponent('tribute_notify_recip_zip', 'name');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('tribute_notify_recip_zip_row', _display);
this.disable_submit_flag(_hidden);
}
observe_component('tribute_show_honor_fields.true', new ComponentDisplayer('tribute_notify_recip_zip'));
</script><noscript> </noscript>
</div>
</div>
<h2 class="section-header-container"> Your Information </h2>
<div id="organization-name-visible_row" class="form-row form-checkbox">
<div class="form-content">
<input type="checkbox" name="organization-name-visiblename" id="organization-name-visiblename" onclick="fire_obs_comp_event('organization-name-visible', this);">
<label for="organization-name-visiblename">I am making this gift on behalf of my company or organization.</label>
<input type="hidden" name="organization-name-visiblesubmit" id="organization-name-visiblesubmit" value="true">
<script type="text/javascript">
var comp = new ObservableComponent('organization-name-visible', 'name');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('organization-name-visible_row', _display);
this.disable_submit_flag(_hidden);
}
comp.set = function(_value) {
if (document.getElementById('organization-name-visiblename')) {
document.getElementById('organization-name-visiblename').checked = _value;
this.fireEvent();
}
}
comp.get = function() {
if (document.getElementById('organization-name-visiblename')) {
return document.getElementById('organization-name-visiblename').checked;
}
}
comp.clear = function() {
this.set(false);
}
</script><noscript> </noscript>
</div>
</div>
<div id="donor-organization-name_row" class="form-row form-text" style="display: none;">
<div class="form-content">
<span class="field-required"></span>
<label for="donor-organization-namename">Organization Name</label>
<input type="text" name="donor-organization-namename" id="donor-organization-namename" value="" maxlength="255" disabled="">
<input type="hidden" name="donor-organization-namesubmit_skip" id="donor-organization-namesubmit" value="true">
<script type="text/javascript">
var comp = new ObservableComponent('donor-organization-name', 'name');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('donor-organization-name_row', _display);
this.disable_submit_flag(_hidden);
}
observe_component('organization-name-visible.true', new ComponentEnabler('donor-organization-name'));
observe_component('organization-name-visible.true', new ComponentDisplayer('donor-organization-name'));
</script><noscript> </noscript>
</div>
</div>
<div id="billing_title_row" class="form-row form-selectlist">
<div class="form-content">
<label class="FormLabel" for="billing_title">Title</label>
<select name="billing_title" id="billing_title" size="1">
<option></option>
<option value="Mr.">Mr.</option>
<option value="Ms.">Ms.</option>
<option value="Mrs.">Mrs.</option>
<option value="Miss">Miss</option>
<option value="Dr.">Dr.</option>
</select>
<script type="text/javascript">
<!--
var comp = new ObservableComponent('billing_title', '');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('billing_title_Row', _display);
this.disable_submit_flag(_hidden);
}
//
-->
</script>
<noscript><br>Required</noscript>
<input type="hidden" name="billing_titlesubmit" id="billing_titlesubmit" value="true">
<script type="text/javascript">
var comp = new ObservableComponent('billing_title', '');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('billing_title_row', _display);
this.disable_submit_flag(_hidden);
}
function billing_title_listChanged(_evt) {
var e = _evt ? _evt : event; // IE vs. Mozilla event model
if (e) {
var src = e.target ? e.target : e.srcElement; // IE vs. Mozilla event model
fire_obs_comp_event('billing_title', src);
}
}
var el = document.getElementById('billing_title');
if (el) {
Utils.addEvent(el, 'change', billing_title_listChanged);
}
</script><noscript> </noscript>
</div>
</div>
<div id="billing_first_name_row" class="form-row form-text">
<div class="form-content">
<span class="field-required"></span>
<label for="billing_first_namename">First Name</label>
<input type="text" name="billing_first_namename" id="billing_first_namename" value="" maxlength="50">
<input type="hidden" name="billing_first_namesubmit" id="billing_first_namesubmit" value="true">
<script type="text/javascript">
var comp = new ObservableComponent('billing_first_name', 'name');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('billing_first_name_row', _display);
this.disable_submit_flag(_hidden);
}
</script><noscript> </noscript>
</div>
</div>
<div id="billing_last_name_row" class="form-row form-text">
<div class="form-content">
<span class="field-required"></span>
<label for="billing_last_namename">Last Name</label>
<input type="text" name="billing_last_namename" id="billing_last_namename" value="" maxlength="50">
<input type="hidden" name="billing_last_namesubmit" id="billing_last_namesubmit" value="true">
<script type="text/javascript">
var comp = new ObservableComponent('billing_last_name', 'name');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('billing_last_name_row', _display);
this.disable_submit_flag(_hidden);
}
</script><noscript> </noscript>
</div>
</div>
<div id="billing_addr_street1_row" class="form-row form-text">
<div class="form-content">
<span class="field-required"></span>
<label for="billing_addr_street1name">Street 1</label>
<input type="text" name="billing_addr_street1name" id="billing_addr_street1name" value="" maxlength="50">
<input type="hidden" name="billing_addr_street1submit" id="billing_addr_street1submit" value="true">
<script type="text/javascript">
var comp = new ObservableComponent('billing_addr_street1', 'name');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('billing_addr_street1_row', _display);
this.disable_submit_flag(_hidden);
}
</script><noscript> </noscript>
</div>
</div>
<div id="billing_addr_street2_row" class="form-row form-text">
<div class="form-content">
<label for="billing_addr_street2name">Street 2 (optional)</label>
<input type="text" name="billing_addr_street2name" id="billing_addr_street2name" value="" maxlength="50">
<input type="hidden" name="billing_addr_street2submit" id="billing_addr_street2submit" value="true">
<script type="text/javascript">
var comp = new ObservableComponent('billing_addr_street2', 'name');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('billing_addr_street2_row', _display);
this.disable_submit_flag(_hidden);
}
</script><noscript> </noscript>
</div>
</div>
<div id="billing_addr_city_row" class="form-row form-text">
<div class="form-content">
<span class="field-required"></span>
<label for="billing_addr_cityname">City</label>
<input type="text" name="billing_addr_cityname" id="billing_addr_cityname" value="" maxlength="50">
<input type="hidden" name="billing_addr_citysubmit" id="billing_addr_citysubmit" value="true">
<script type="text/javascript">
var comp = new ObservableComponent('billing_addr_city', 'name');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('billing_addr_city_row', _display);
this.disable_submit_flag(_hidden);
}
</script><noscript> </noscript>
</div>
</div>
<div id="billing_addr_state_row" class="form-row form-selectlist">
<div class="form-content">
<span class="field-required"></span>
<label class="FormLabel" for="billing_addr_state">State/Province</label>
<select name="billing_addr_state" id="billing_addr_state" size="1" onchange="fire_obs_comp_event('billing_addr_state', this)">
<option></option>
<option value="AK">AK - Alaska</option>
<option value="AL">AL - Alabama</option>
<option value="AR">AR - Arkansas</option>
<option value="AZ">AZ - Arizona</option>
<option value="CA">CA - California</option>
<option value="CO">CO - Colorado</option>
<option value="CT">CT - Connecticut</option>
<option value="DC">DC - District of Columbia</option>
<option value="DE">DE - Delaware</option>
<option value="FL">FL - Florida</option>
<option value="GA">GA - Georgia</option>
<option value="HI">HI - Hawaii</option>
<option value="IA">IA - Iowa</option>
<option value="ID">ID - Idaho</option>
<option value="IL">IL - Illinois</option>
<option value="IN">IN - Indiana</option>
<option value="KS">KS - Kansas</option>
<option value="KY">KY - Kentucky</option>
<option value="LA">LA - Louisiana</option>
<option value="MA">MA - Massachusetts</option>
<option value="MD">MD - Maryland</option>
<option value="ME">ME - Maine</option>
<option value="MI">MI - Michigan</option>
<option value="MN">MN - Minnesota</option>
<option value="MO">MO - Missouri</option>
<option value="MS">MS - Mississippi</option>
<option value="MT">MT - Montana</option>
<option value="NC">NC - North Carolina</option>
<option value="ND">ND - North Dakota</option>
<option value="NE">NE - Nebraska</option>
<option value="NH">NH - New Hampshire</option>
<option value="NJ">NJ - New Jersey</option>
<option value="NM">NM - New Mexico</option>
<option value="NV">NV - Nevada</option>
<option value="NY">NY - New York</option>
<option value="OH">OH - Ohio</option>
<option value="OK">OK - Oklahoma</option>
<option value="OR">OR - Oregon</option>
<option value="PA">PA - Pennsylvania</option>
<option value="RI">RI - Rhode Island</option>
<option value="SC">SC - South Carolina</option>
<option value="SD">SD - South Dakota</option>
<option value="TN">TN - Tennessee</option>
<option value="TX">TX - Texas</option>
<option value="UT">UT - Utah</option>
<option value="VA">VA - Virginia</option>
<option value="VT">VT - Vermont</option>
<option value="WA">WA - Washington</option>
<option value="WI">WI - Wisconsin</option>
<option value="WV">WV - West Virginia</option>
<option value="WY">WY - Wyoming</option>
<option value="AS">AS - American Samoa</option>
<option value="FM">FM - Federated States of Micronesia</option>
<option value="GU">GU - Guam</option>
<option value="MH">MH - Marshall Islands</option>
<option value="MP">MP - Northern Mariana Islands</option>
<option value="PR">PR - Puerto Rico</option>
<option value="PW">PW - Palau</option>
<option value="VI">VI - Virgin Islands</option>
<option value="AA">AA - Armed Forces Americas</option>
<option value="AE">AE - Armed Forces</option>
<option value="AP">AP - Armed Forces Pacific</option>
<option value="AB">AB - Alberta</option>
<option value="BC">BC - British Columbia</option>
<option value="MB">MB - Manitoba</option>
<option value="NB">NB - New Brunswick</option>
<option value="NL">NL - Newfoundland and Labrador</option>
<option value="NS">NS - Nova Scotia</option>
<option value="NT">NT - Northwest Territories</option>
<option value="NU">NU - Nunavut</option>
<option value="ON">ON - Ontario</option>
<option value="PE">PE - Prince Edward Island</option>
<option value="QC">QC - Quebec</option>
<option value="SK">SK - Saskatchewan</option>
<option value="YT">YT - Yukon</option>
<option value="None">None</option>
</select>
<script type="text/javascript">
<!--
var comp = new ObservableComponent('billing_addr_state', '');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('billing_addr_state_Row', _display);
this.disable_submit_flag(_hidden);
}
//
-->
</script>
<noscript><br>Required</noscript>
<input type="hidden" name="billing_addr_statesubmit" id="billing_addr_statesubmit" value="true">
<script type="text/javascript">
var comp = new ObservableComponent('billing_addr_state', '');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('billing_addr_state_row', _display);
this.disable_submit_flag(_hidden);
}
function billing_addr_state_listChanged(_evt) {
var e = _evt ? _evt : event; // IE vs. Mozilla event model
if (e) {
var src = e.target ? e.target : e.srcElement; // IE vs. Mozilla event model
fire_obs_comp_event('billing_addr_state', src);
}
}
var el = document.getElementById('billing_addr_state');
if (el) {
Utils.addEvent(el, 'change', billing_addr_state_listChanged);
}
</script><noscript> </noscript>
</div>
</div>
<div id="billing_addr_zip_row" class="form-row form-text">
<div class="form-content">
<span class="field-required"></span>
<label for="billing_addr_zipname">ZIP Code</label>
<input type="text" name="billing_addr_zipname" id="billing_addr_zipname" value="" maxlength="50">
<input type="hidden" name="billing_addr_zipsubmit" id="billing_addr_zipsubmit" value="true">
<script type="text/javascript">
var comp = new ObservableComponent('billing_addr_zip', 'name');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('billing_addr_zip_row', _display);
this.disable_submit_flag(_hidden);
}
</script><noscript> </noscript>
</div>
</div>
<div id="donor_phone_row" class="form-row form-text">
<div class="form-content">
<label for="donor_phonename">Phone Number</label>
<input type="text" name="donor_phonename" id="donor_phonename" value="" maxlength="50">
<input type="hidden" name="donor_phonesubmit" id="donor_phonesubmit" value="true">
<script type="text/javascript">
var comp = new ObservableComponent('donor_phone', 'name');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('donor_phone_row', _display);
this.disable_submit_flag(_hidden);
}
</script><noscript> </noscript>
</div>
</div>
<div id="donor_email_address_row" class="form-row form-text">
<div class="form-content">
<span class="field-required"></span>
<label for="donor_email_addressname">Email Address</label>
<input type="text" name="donor_email_addressname" id="donor_email_addressname" value="" maxlength="255">
<input type="hidden" name="donor_email_addresssubmit" id="donor_email_addresssubmit" value="true">
<script type="text/javascript">
var comp = new ObservableComponent('donor_email_address', 'name');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('donor_email_address_row', _display);
this.disable_submit_flag(_hidden);
}
</script><noscript> </noscript>
</div>
</div>
<div id="anonymous_donation_row" class="form-row form-checkbox">
<div class="form-content">
<input type="checkbox" name="anonymous_donationname" id="anonymous_donationname" onclick="fire_obs_comp_event('anonymous_donation', this);">
<label for="anonymous_donationname">I would like to make this donation anonymously.</label>
<input type="hidden" name="anonymous_donationsubmit" id="anonymous_donationsubmit" value="true">
<script type="text/javascript">
var comp = new ObservableComponent('anonymous_donation', 'name');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('anonymous_donation_row', _display);
this.disable_submit_flag(_hidden);
}
comp.set = function(_value) {
if (document.getElementById('anonymous_donationname')) {
document.getElementById('anonymous_donationname').checked = _value;
this.fireEvent();
}
}
comp.get = function() {
if (document.getElementById('anonymous_donationname')) {
return document.getElementById('anonymous_donationname').checked;
}
}
comp.clear = function() {
this.set(false);
}
</script><noscript> </noscript>
</div>
</div>
<div class="form-row form-checkbox" id="donor_email_opt_in_Row">
<div class="form-content">
<span class="check-box-form-label-text"></span>
<input type="checkbox" name="donor_email_opt_inname" id="donor_email_opt_inname" checked="checked" onclick="fire_obs_comp_event('donor_email_opt_in', this);">
<label for="donor_email_opt_inname"> I'd like to receive email updates from Geisinger Health Foundation. </label>
<script type="text/javascript">
var comp = new ObservableComponent('donor_email_opt_in', 'name');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('donor_email_opt_in_Row', _display);
this.disable_submit_flag(_hidden);
}
comp.set = function(_value) {
if (document.getElementById('donor_email_opt_inname')) {
document.getElementById('donor_email_opt_inname').checked = _value;
this.fireEvent();
}
}
comp.get = function() {
if (document.getElementById('donor_email_opt_inname')) return document.getElementById('donor_email_opt_inname').checked;
}
comp.clear = function() {
this.set(false);
}
</script><noscript> </noscript>
<input type="hidden" name="donor_email_opt_insubmit" id="donor_email_opt_insubmit" value="true">
</div>
</div>
<h2 class="section-header-container"> Payment Information </h2>
<div class="payment-type-element-container">
<div class="payment-type-selection-container payment-field-container">
<h3>Payment</h3>
<div id="responsive_payment_typepay_typeradio_row" class="form-row">
<div class="form-content">
<div class="payment-type-selections" id="responsive_payment_typepay_typeradio_payment_types">
<span class="internal-payment"><span class="payment-type-option selected"><input type="radio" name="responsive_payment_typepay_typeradio" id="responsive_payment_typepay_typeradiocredit" value="credit" checked="checked"
onclick="fire_obs_comp_event('responsive_payment_typepay_typeradio', this);" onkeypress="fire_obs_comp_event('responsive_payment_typepay_typeradio', this);"><label for="responsive_payment_typepay_typeradiocredit">Credit
Card</label>
<script type="text/javascript">
var comp = new ObservableRadioComponent('responsive_payment_typepay_typeradio', 'name');
</script><noscript> </noscript>
</span><span class="payment-type-option"><input type="radio" name="responsive_payment_typepay_typeradio" id="responsive_payment_typepay_typeradioach" value="ach"
onclick="fire_obs_comp_event('responsive_payment_typepay_typeradio', this);" onkeypress="fire_obs_comp_event('responsive_payment_typepay_typeradio', this);"><label for="responsive_payment_typepay_typeradioach">Checking
Account</label>
<script type="text/javascript">
var comp = new ObservableRadioComponent('responsive_payment_typepay_typeradio', 'name');
</script><noscript> </noscript>
</span></span>
<span class="external-payment"></span>
</div>
<input type="hidden" name="responsive_payment_typepay_typeradiosubmit" id="responsive_payment_typepay_typeradiosubmit" value="true">
<script type="text/javascript">
Y.use("jquery-ui", function(Y) {
jQuery(function() {
// subscribe observable for payment type options
jQuery('.payment-type-option').each(function() {
var syncAction = function(obj) {
if (obj.hasClass('selected')) {
var radioGroupName = obj.find('input').attr('name');
obj.find('input').prop('checked', true);
fire_obs_comp_event(radioGroupName, obj.find('input').get());
}
return arguments.callee;
}(jQuery(this));
jQuery(this).click(function() {
jQuery('.payment-type-option').removeClass('selected');
jQuery(this).addClass('selected');
syncAction(jQuery(this));
var selectedValue = jQuery(this).find('input').val();
if (selectedValue == 'paypal' || selectedValue == 'amazon') {
// open up a boxinator dialog
jQuery(document).trigger('redirect-external');
jQuery('#btn_next').click();
}
});
});
});
});
var comp = new ObservableRadioComponent('responsive_payment_typepay_typeradio', 'name');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('responsive_payment_typepay_typeradio_row', _display);
this.disable_submit_flag(_hidden);
}
</script><noscript> </noscript>
</div>
</div>
</div>
<div id="payment_cc_container" class="payment-field-container">
<h3>Credit Card Information:</h3>
<div id="responsive_payment_typecc_type_row" class="form-row form-radio-array">
<div class="form-content">
<fieldset>
<legend>Credit Card Type:</legend>
<ul class="radio-array-list">
<li class="tender-row ">
<img src="../images/visa_small.gif" alt="Visa" name="responsive_payment_typecc_type_Visa" id="responsive_payment_typecc_type_Visa">
</li>
<li class="tender-row ">
<img src="../images/discovercard_sm.gif" alt="Discover" name="responsive_payment_typecc_type_Discover" id="responsive_payment_typecc_type_Discover">
</li>
<li class="tender-row ">
<img src="../images/amex_small.gif" alt="American Express" name="responsive_payment_typecc_type_American_Express" id="responsive_payment_typecc_type_American_Express">
</li>
<li class="tender-row ">
<img src="../images/mastercd_small.gif" alt="MasterCard" name="responsive_payment_typecc_type_MasterCard" id="responsive_payment_typecc_type_MasterCard">
</li>
</ul>
</fieldset>
<input type="hidden" name="responsive_payment_typecc_typesubmit" id="responsive_payment_typecc_typesubmit" value="true">
<script type="text/javascript">
var comp = new ObservableRadioComponent('responsive_payment_typecc_type', 'name');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('responsive_payment_typecc_type_row', _display);
this.disable_submit_flag(_hidden);
}
</script><noscript> </noscript>
</div>
</div>
<div id="responsive_payment_typecc_number_row" class="form-row form-text">
<div class="form-content">
<span class="field-required"></span>
<label for="responsive_payment_typecc_numbername">Credit Card Number:</label>
<input type="text" name="responsive_payment_typecc_numbername" id="responsive_payment_typecc_numbername" value="" maxlength="22" autocomplete="off">
<input type="hidden" name="responsive_payment_typecc_numbersubmit" id="responsive_payment_typecc_numbersubmit" value="true">
<script type="text/javascript">
var comp = new ObservableComponent('responsive_payment_typecc_number', 'name');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('responsive_payment_typecc_number_row', _display);
this.disable_submit_flag(_hidden);
}
observe_component('null', new ComponentDisplayer('responsive_payment_typecc_number'));
</script><noscript> </noscript>
</div>
</div>
<div id="responsive_payment_typecc_exp_date_row" class="form-row form-date">
<div class="form-content">
<span class="field-required"></span>
<label for="responsive_payment_typecc_exp_date_MONTH">
<span class="label-text">Expiration Date:</span><span class="aural-only">Select month of credit card</span>
</label>
<label for="responsive_payment_typecc_exp_date_YEAR"><span class="aural-only">Select Expiration Year</span></label>
<div class="date-input-container">
<fieldset class="cardExpGroup">
<select name="responsive_payment_typecc_exp_date_MONTH" id="responsive_payment_typecc_exp_date_MONTH" onchange="fire_obs_comp_event('responsive_payment_typecc_exp_date_MONTH', this)">
<option value="1" selected="selected">01</option>
<option value="2">02</option>
<option value="3">03</option>
<option value="4">04</option>
<option value="5">05</option>
<option value="6">06</option>
<option value="7">07</option>
<option value="8">08</option>
<option value="9">09</option>
<option value="10">10</option>
<option value="11">11</option>
<option value="12">12</option>
</select>
<select name="responsive_payment_typecc_exp_date_YEAR" id="responsive_payment_typecc_exp_date_YEAR" onchange="fire_obs_comp_event('responsive_payment_typecc_exp_date_YEAR', this)">
<option value="2022" selected="selected">2022</option>
<option value="2023">2023</option>
<option value="2024">2024</option>
<option value="2025">2025</option>
<option value="2026">2026</option>
<option value="2027">2027</option>
<option value="2028">2028</option>
<option value="2029">2029</option>
<option value="2030">2030</option>
<option value="2031">2031</option>
<option value="2032">2032</option>
</select>
</fieldset>
<input type="hidden" name="responsive_payment_typecc_exp_date_DAY" id="responsive_payment_typecc_exp_date_DAY" value="1">
<script type="text/javascript">
<!--
var comp1 = new ObservableComponent('responsive_payment_typecc_exp_date_MONTH', '');
comp1.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('responsive_payment_typecc_exp_date_Row', _display);
this.disable_submit_flag(_hidden);
}
var comp2 = new ObservableComponent('responsive_payment_typecc_exp_date_YEAR', '');
comp2.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('responsive_payment_typecc_exp_date_Row', _display);
this.disable_submit_flag(_hidden);
}
//
-->
</script><noscript> </noscript>
</div>
<input type="hidden" name="responsive_payment_typecc_exp_datesubmit" id="responsive_payment_typecc_exp_datesubmit" value="true">
<script type="text/javascript">
var comp = new ObservableComponent('responsive_payment_typecc_exp_date', 'input');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('responsive_payment_typecc_exp_date_row', _display);
disable_submit_flag('responsive_payment_typecc_exp_datesubmit', _hidden);
}
comp.disable = function(_disabled) {
disable_element('responsive_payment_typecc_exp_date_MONTH', _disabled);
disable_element('responsive_payment_typecc_exp_date_DAY', _disabled);
disable_element('responsive_payment_typecc_exp_date_YEAR', _disabled);
disable_element('responsive_payment_typecc_exp_date_HOUR12', _disabled);
disable_element('responsive_payment_typecc_exp_date_HOUR24', _disabled); //For UK, 24 hour clock used
disable_element('responsive_payment_typecc_exp_date_MINUTE', _disabled);
disable_element('responsive_payment_typecc_exp_date_AMPM', _disabled);
}
</script><noscript> </noscript>
</div>
</div>
<div id="responsive_payment_typecc_cvv_row" class="form-row form-text cvv-input">
<div class="form-content">
<span class="field-required"></span>
<label for="responsive_payment_typecc_cvvname">
<span class="FormLabelText">CVV Number:</span>
</label>
<a href="http://help.convio.net/site/PageServer?s_site=gss&pagename=user_donation_cvv" class="HelpLink" title="What is this? Opens new window.">What is this?</a>
<input type="text" name="responsive_payment_typecc_cvvname" id="responsive_payment_typecc_cvvname" value="" maxlength="4" autocomplete="cc-csc">
<input type="hidden" name="responsive_payment_typecc_cvvsubmit" id="responsive_payment_typecc_cvvsubmit" value="true">
<script type="text/javascript">
//chrome is mapping cvv as card name
if (/Chrome/.test(navigator.userAgent) && /Google Inc/.test(navigator.vendor)) {
document.getElementById('responsive_payment_typecc_cvvname').autocomplete = 'cc-csc';
}
var comp = new ObservableComponent('responsive_payment_typecc_cvv', 'name');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('responsive_payment_typecc_cvv_row', _display);
this.disable_submit_flag(_hidden);
}
</script><noscript> </noscript>
</div>
</div>
</div>
<div id="payment_bank_container" class="payment-field-container" style="display: none;">
<h3>Checking Account Information</h3>
<div id="responsive_payment_typerouting_number_row" class="form-row form-text">
<div class="form-content">
<span class="field-required"></span>
<label for="responsive_payment_typerouting_numbername">Bank Routing Number:</label>
<a href="http://help.convio.net/site/PageServer?s_site=gss&pagename=User_Donation_ACH" class="HelpLink" title="What is this? Opens new window.">What is this?</a>
<input type="text" name="responsive_payment_typerouting_numbername" id="responsive_payment_typerouting_numbername" value="" size="20" maxlength="20" onchange="fire_obs_comp_event('responsive_payment_typerouting_number', this);"
autocomplete="off">
<input type="hidden" name="responsive_payment_typerouting_numbersubmit" id="responsive_payment_typerouting_numbersubmit" value="true">
<script type="text/javascript">
var comp = new ObservableComponent('responsive_payment_typerouting_number', 'name');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('responsive_payment_typerouting_number_row', _display);
this.disable_submit_flag(_hidden);
}
</script><noscript> </noscript>
</div>
</div>
<div id="responsive_payment_typebank_account_row" class="form-row form-text">
<div class="form-content">
<span class="field-required"></span>
<label for="responsive_payment_typebank_accountname">Bank Account Number:</label>
<input type="text" name="responsive_payment_typebank_accountname" id="responsive_payment_typebank_accountname" value="" maxlength="20" autocomplete="off">
<input type="hidden" name="responsive_payment_typebank_accountsubmit" id="responsive_payment_typebank_accountsubmit" value="true">
<script type="text/javascript">
var comp = new ObservableComponent('responsive_payment_typebank_account', 'name');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('responsive_payment_typebank_account_row', _display);
this.disable_submit_flag(_hidden);
}
observe_component('null', new ComponentDisplayer('responsive_payment_typebank_account'));
</script><noscript> </noscript>
</div>
</div>
<div id="responsive_payment_typeverify_bank_account_row" class="form-row form-text">
<div class="form-content">
<span class="field-required"></span>
<label for="responsive_payment_typeverify_bank_accountname">Verify Bank Account Number:</label>
<input type="text" name="responsive_payment_typeverify_bank_accountname" id="responsive_payment_typeverify_bank_accountname" value="" maxlength="20" autocomplete="off">
<input type="hidden" name="responsive_payment_typeverify_bank_accountsubmit" id="responsive_payment_typeverify_bank_accountsubmit" value="true">
<script type="text/javascript">
var comp = new ObservableComponent('responsive_payment_typeverify_bank_account', 'name');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('responsive_payment_typeverify_bank_account_row', _display);
this.disable_submit_flag(_hidden);
}
observe_component('null', new ComponentDisplayer('responsive_payment_typeverify_bank_account'));
</script><noscript> </noscript>
</div>
</div>
<div id="responsive_payment_type.account_type_row" class="form-row form-radio-array">
<div class="form-content">
<fieldset>
<legend><span class="field-required"></span> Account Type:</legend>
<ul class="radio-array-list">
<li>
<input type="radio" name="responsive_payment_type.account_type" id="responsive_payment_type.account_type_responsive_payment_typeaccount_type_checking" value="CHECKING"
onclick="fire_obs_comp_event('responsive_payment_type.account_type', this);">
<span class="radio-label">
<label for="responsive_payment_type.account_type_responsive_payment_typeaccount_type_checking">Checking</label>
</span>
</li>
<li>
<input type="radio" name="responsive_payment_type.account_type" id="responsive_payment_type.account_type_responsive_payment_typeaccount_type_savings" value="SAVINGS"
onclick="fire_obs_comp_event('responsive_payment_type.account_type', this);">
<span class="radio-label">
<label for="responsive_payment_type.account_type_responsive_payment_typeaccount_type_savings">Savings</label>
</span>
</li>
</ul>
</fieldset>
<input type="hidden" name="responsive_payment_type.account_typesubmit" id="responsive_payment_type.account_typesubmit" value="true">
<script type="text/javascript">
var comp = new ObservableRadioComponent('responsive_payment_type.account_type', 'name');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('responsive_payment_type.account_type_row', _display);
this.disable_submit_flag(_hidden);
}
</script><noscript> </noscript>
</div>
</div>
<div id="responsive_payment_typeach_confirm_row" class="form-row form-checkbox">
<div class="form-content">
<span class="field-required"></span>
<input type="checkbox" name="responsive_payment_typeach_confirmname" id="responsive_payment_typeach_confirmname" onclick="fire_obs_comp_event('responsive_payment_typeach_confirm', this);">
<label for="responsive_payment_typeach_confirmname">By checking this option, I agree to use my bank account as a payment method and authorize this organization to debit my bank account to fulfill my donation commitment.</label>
<input type="hidden" name="responsive_payment_typeach_confirmsubmit" id="responsive_payment_typeach_confirmsubmit" value="true">
<script type="text/javascript">
var comp = new ObservableComponent('responsive_payment_typeach_confirm', 'name');
comp.hide = function(_hidden) {
var _display = _hidden ? 'none' : '';
set_display('responsive_payment_typeach_confirm_row', _display);
this.disable_submit_flag(_hidden);
}
comp.set = function(_value) {
if (document.getElementById('responsive_payment_typeach_confirmname')) {
document.getElementById('responsive_payment_typeach_confirmname').checked = _value;
this.fireEvent();
}
}
comp.get = function() {
if (document.getElementById('responsive_payment_typeach_confirmname')) {
return document.getElementById('responsive_payment_typeach_confirmname').checked;
}
}
comp.clear = function() {
this.set(false);
}
observe_component('null', new ComponentEnabler('responsive_payment_typeach_confirm'));
</script><noscript> </noscript>
</div>
</div>
</div>
<div id="payment_check_container" class="payment-field-container" style="display: none;">
<h3>Check Information</h3>
</div>
<input type="hidden" name="responsive_payment_typesubmit" id="responsive_payment_typesubmit" value="true">
<script type="text/javascript">
function PaymentObserver() {
this.observe = function(_event) {
var sVal = _event.component.get();
switch (sVal) {
case 'check':
hide_element('payment_cc_container');
hide_element('payment_bank_container');
show_element('payment_check_container');
break;
case 'credit':
hide_element('payment_bank_container');
hide_element('payment_check_container');
show_element('payment_cc_container');
break;
case 'ach':
hide_element('payment_cc_container');
hide_element('payment_check_container');
show_element('payment_bank_container');
break;
case 'paypal':
case 'amazon':
case 'mobilepay':
default:
// hide all
hide_element('payment_bank_container');
hide_element('payment_cc_container');
hide_element('payment_check_container');
break;
}
}
}
// Set the observer to show/hide the relevant fields
observe_component('responsive_payment_typepay_typeradio', new PaymentObserver());
</script><noscript> </noscript>
</div>
<div class="button-container clearfix">
<div class="button-sub-container">
<button class="step-button action-button finish-step" type="submit" id="pstep_finish" name="pstep_finish" value="Donate $">Donate $<span class="amtmonies">250</span><span class="amttimes" style="display: none;"> per
month</span></button><small class="error" style="margin-left: 10px;"></small>
</div>
</div>
<input type="hidden" name="idb" id="idb" value="1268966739">
<input type="hidden" name="df_id" id="df_id" value="1740">
<input type="hidden" name="mfc_pref" id="mfc_pref" value="T">
<div class="form-row">
<div class="html-caption-container">
<p>
<style type="text/css">
<!--
div.donation-level-container {
float: left;
margin-right: 20px;
}
label+div.donation-level-user-entered {
margin-left: 4px;
display: inline-block;
margin-top: 0px;
}
input[type="radio"] {
margin: 5px 0 0 0;
}
div.donation-level-input-container,
div.generic-repeat-label-checkbox-container {
padding: 0 0 10px;
}
div.responsive div.form-content {
margin-bottom: 0;
margin-right: 0;
margin-top: 0;
}
#billing_first_name_row,
#billing_middle_name_row,
#billing_last_name_row {
float: left;
margin-right: 10px;
}
#billing_addr_street1_row {
clear: both;
}
div.donation-level-input-container,
div.generic-repeat-label-checkbox-container {
padding: 0;
}
div.donation-level-user-entered {
display: block;
float: right;
margin-left: 5px;
}
div.donation-level-amount-container {
margin-top: 5px;
}
div.donation-level-label-container {
margin-top: 3px;
}
div.button-container {
border-top: 0 none;
margin-top: 0;
padding-top: 0;
}
#pstep_cancel {
display: none;
}
div.button-container {
display: inline-block;
}
div.form-row {
margin-top: 15px;
}
-->
</style>
</p>
</div>
</div>
</div>
<input type="hidden" name="1740.donation" id="1740.donation" value="form1">
</div>
<script type="text/javascript">
var submitted = false;
function checkDoubleClick() {
var elCheck = '';
if (elCheck == 'el') {
alert('Form submission is not enabled when previewing an individual data element.');
return false;
} else if (submitted) {
alert('You have already submitted this payment. Please wait....');
return false;
} else {
submitted = true;
return true;
}
}
</script><noscript> </noscript>
</form>Text Content
GEISINGER HEALTH FOUNDATION * Make better health easy for all by giving to Geisinger Field Is Required Donate to Geisinger Health Foundation $25 $50 $75 $100 $250 $500 $750 $1,000 $5,000 Enter Amount Enter amount Donor Entered Amount Enter amount Field Is Required Gift Designation: Direct my gift to: Health System Priorities Geisinger Commonwealth School of Medicine Scholarships Henry Cancer Center at GWV Janet Weis Children's Hospital Other Required Direct my gift to: Yes, repeat my gift monthly. This is a memorial gift or in honor of someone. Gift Type In Memory of In Honor of Required Honoree First Name Honoree Last Name Send gift notification to: First Name Last Name Street 1 Street 2 (optional) City State/Province AK - Alaska AL - Alabama AR - Arkansas AZ - Arizona CA - California CO - Colorado CT - Connecticut DC - District of Columbia DE - Delaware FL - Florida GA - Georgia HI - Hawaii IA - Iowa ID - Idaho IL - Illinois IN - Indiana KS - Kansas KY - Kentucky LA - Louisiana MA - Massachusetts MD - Maryland ME - Maine MI - Michigan MN - Minnesota MO - Missouri MS - Mississippi MT - Montana NC - North Carolina ND - North Dakota NE - Nebraska NH - New Hampshire NJ - New Jersey NM - New Mexico NV - Nevada NY - New York OH - Ohio OK - Oklahoma OR - Oregon PA - Pennsylvania RI - Rhode Island SC - South Carolina SD - South Dakota TN - Tennessee TX - Texas UT - Utah VA - Virginia VT - Vermont WA - Washington WI - Wisconsin WV - West Virginia WY - Wyoming AS - American Samoa FM - Federated States of Micronesia GU - Guam MH - Marshall Islands MP - Northern Mariana Islands PR - Puerto Rico PW - Palau VI - Virgin Islands AA - Armed Forces Americas AE - Armed Forces AP - Armed Forces Pacific AB - Alberta BC - British Columbia MB - Manitoba NB - New Brunswick NL - Newfoundland and Labrador NS - Nova Scotia NT - Northwest Territories NU - Nunavut ON - Ontario PE - Prince Edward Island QC - Quebec SK - Saskatchewan YT - Yukon None Required ZIP Code YOUR INFORMATION I am making this gift on behalf of my company or organization. Organization Name Title Mr. Ms. Mrs. Miss Dr. Required First Name Last Name Street 1 Street 2 (optional) City State/Province AK - Alaska AL - Alabama AR - Arkansas AZ - Arizona CA - California CO - Colorado CT - Connecticut DC - District of Columbia DE - Delaware FL - Florida GA - Georgia HI - Hawaii IA - Iowa ID - Idaho IL - Illinois IN - Indiana KS - Kansas KY - Kentucky LA - Louisiana MA - Massachusetts MD - Maryland ME - Maine MI - Michigan MN - Minnesota MO - Missouri MS - Mississippi MT - Montana NC - North Carolina ND - North Dakota NE - Nebraska NH - New Hampshire NJ - New Jersey NM - New Mexico NV - Nevada NY - New York OH - Ohio OK - Oklahoma OR - Oregon PA - Pennsylvania RI - Rhode Island SC - South Carolina SD - South Dakota TN - Tennessee TX - Texas UT - Utah VA - Virginia VT - Vermont WA - Washington WI - Wisconsin WV - West Virginia WY - Wyoming AS - American Samoa FM - Federated States of Micronesia GU - Guam MH - Marshall Islands MP - Northern Mariana Islands PR - Puerto Rico PW - Palau VI - Virgin Islands AA - Armed Forces Americas AE - Armed Forces AP - Armed Forces Pacific AB - Alberta BC - British Columbia MB - Manitoba NB - New Brunswick NL - Newfoundland and Labrador NS - Nova Scotia NT - Northwest Territories NU - Nunavut ON - Ontario PE - Prince Edward Island QC - Quebec SK - Saskatchewan YT - Yukon None Required ZIP Code Phone Number Email Address I would like to make this donation anonymously. 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